An optimistic view of OPTIMISE II?

Rupert Pearse’ OPTIMISE trial published in 2014 found that “use of a cardiac output–guided hemodynamic therapy algorithm compared with usual care did not reduce a composite outcome of complications and 30-day mortality.” My concern about the protocol was that it obliged research anaesthetists to give colloid solutions to all the

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Albumin, the EGL, vascular permeability and trout fishing.

Jon-Emile Kenny is a New York physician who has recently joined the FOAMEd movement, and is opening his PulmCrit account with a blast around the steady-state Starling principle. http://pulmccm.org/main/2016/ards-review/revised-starling-principle-implications-rational-fluid-therapy/ It seems JE has read RSE&GM 2012 and is concerned about his propensity to prescribe hyperoncotic albumin with furosemide to cirrhotic

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We should engineer a new crystalloid?

My post on bag wars was hardly posted when Josh Farkas’ excellent PulmCrit posted an recipe for a Universal Panacea. http://emcrit.org/pulmcrit/crystalloid/ My own foray into this arena was 19 years ago ncbi.nlm.nih.gov/pubmed/9349085 “An improved Hartmann’s solution for anaesthetists in the 1990s”. Before you read it, please note it is heavily

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Faculty of 1000

Do you despair of waiting months, maybe years for Publication of research results you saw previewed at a recent Conference? Have you been frustrated by Editors who publish only positive studies in their prestigious Journal, and wondered what changes they have demanded to the submitted Manuscript? Do you wonder why

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found a pearl.

I think the modern phrase is “I need to get my head around [insert here]”, and I fully accept that the glycocalyx model (Michel-Weinbaum model) is one concept it is hard to get your head around. Unfortunately you can’t be a rational prescriber of fluids if you haven’t got your

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Introducing fluidphysiology.org

Re-educating the world about the steady-state Starling principle is not going to be quick or easy. Almost every textbook and Review article until very recently has been perpetuating the capillary transendothelial filtration – absorption doctrine of antiquity. In 2004 Adamson et al showed that only filtration occurs at steady state,

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