How I provide fluid therapy in sepsis - Professor Anders Perner

The AVF Podcast: ICU Tips & Tricks invites colleagues to share anything and everything on how they deal with various clinical situations. Expect discussions on how experts personalise evidence-based medicine for the patient at the bedside.

In this episode, Professor Anders Perner discusses how he provides fluid therapy in patients with sepsis. Professor Perner is a senior staff specialist and professor in intensive care at Rigshospitalet, University of Copenhagen and an honorary professor of the George Institute in Sydney. He chairs the Danish National Centre for Research in Intensive Care and the Scandinavian Critical Care Trials Group. He was the chair of three land-mark trials, the 6S, TRISS, and CLASSIC trials, the results of which have improved the fluid and transfusion therapy of patients with sepsis.

Issues discussed in this interview:
• What to look out for when deciding on fluid therapy
• Restrictive versus standard fluid therapy
• Whether the guideline of 30 mL/kg of crystalloids remains valid
• When to start vasopressors
• Buffered crystalloids or 0.9% saline or albumin
• Limitations of markers of pre-load responsiveness
• Removal of fluid after stabilisation
• Importance of evidenced-based medicine and randomised controlled trials

Work cited:
1. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021;47:1181-247.
2. Meyhoff TS, Hjortrup PB, Wetterslev J, et al. Restriction of intravenous fluid in ICU patients with septic shock. N Engl J Med 2022;386:2459-70.