In septic shock with suspected intra-abdominal source, which aspect of the Surviving Sepsis Campaign 'Hour-1 Bundle' (2018) has been most controversially debated following the FEAST and PROCESS/ARISE/ProMISe trials?
- A Blood cultures before antibiotics
- B 30 mL/kg IV crystalloid fluid bolus for hypotension/lactate ≥4 mmol/L ✓
- C Broad-spectrum antibiotics within 1 hour
- D Norepinephrine for MAP below 65 mmHg
Correct answer: B. 30 mL/kg IV crystalloid fluid bolus for hypotension/lactate ≥4 mmol/L
Explanation
The mandatory 30 mL/kg crystalloid bolus in the Hour-1 Bundle has been questioned following the FEAST trial (showing harm from bolus fluids in African children), and the PROCESS, ARISE, and ProMISe trials which showed no benefit of protocolized early goal-directed therapy (including aggressive fluid loading) over usual care. The SMART and SPLIT trials also showed balanced crystalloids may be superior to normal saline. Individualized fluid resuscitation guided by dynamic measures of fluid responsiveness is now favoured over fixed-volume protocols.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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