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Critical Care Mailbag - Sepsis: Blood Pressure Targets - ProCESS and Albumin

Scott Weingart, MD and Rob Orman, MD
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30:54
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Nurses Edition Commentary

Mel Herbert, MD MBBS FAAEM, Lisa Chavez, RN, and Kathy Garvin, RN
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01:27

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EM:RAP 2014 August - Summary 1 MB - PDF

It turns out that the gold standard in sepsis management might not be so gold after all.

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Alex K. -

Do you think there is any value in any of the subgroup or post-hoc analyses of either SEPSISPAM or ALBIOS? Specifically the lack of increase in serum creatinine and need for RRT in the chronically hypertensive patients who received a higher MAP goal; and the post-hoc mortality improvement at 90 days for those with defined septic shock who received albumin (feels similar to the suggestion of efficacy found in SAFE?).

Or are these just some statistical gymnastics? The authors of ALBIOS admit readily that this was not a planned outcome and may be subject to bias.

I think physiologically the kidney-oriented outcomes make sense and may be meaningful in the SEPSISPAM trial, though I don't know if the result gives and exact clinical utility. Maybe aim higher and titrate to urine output? Mostly just thinking out loud but I don't think the book is closed yet.

EMCrit -

at this stage, >65 is all we can say for sure. Will have an extensive podcast on this very topic including the studies you menion

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Episode 155 Full episode audio for MD edition 275:00 min - 131 MB - M4AEM:RAP 2014 août Résumé en Francais Français 65:33 min - 60 MB - MP3EM:RAP 2014 August Aussie Edition Australian 73:57 min - 102 MB - MP3EM:RAP 2014 August Canadian Edition Canadian 30:52 min - 43 MB - MP3EM:RAP 2014 Augusto Resumen Español Español 83:27 min - 77 MB - MP3EM:RAP 2014 August MP3 359 MB - ZIPEM:RAP 2014 August - Summary 1 MB - PDFEM:RAP 2014 August Board Review Questions 379 KB - PDFEM:RAP 2014 August Board Review Answers 421 KB - PDF

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