The very 1st line of a recent @BJAJournals states: 'In early critical illness, intravascular volume depletion secondary to capillary leak is common & requires aggressive fluid resuscitation to improve cardiac output & tissue perfusion' Why are we still propagating these myths? 🧵
2/ The article itself is a nice review of diuretics in critical care. bit.ly/3HwW7kM Leaving that to 1 side - Let's take the 3 hypotheses (myths) presented in this opening sentence one by one...
@icmteaching @BJAJournals Great thread! This is well illustrated in dengue fever. There hallmark is extensive disruption of EGC and plasma leak. At a steady state, there is hypovolemia and extensive third space fluids/edema. Fluid resuscitation is cornerstone; however, therapeutic window is narrow.
@icmteaching @BJAJournals You have a point, though capillary leak is real and has been demonstrated by a number of mechanisms Still agree we should be our challenging assumptions especially when outcome based evidence is thin icm-experimental.springeropen.com/articles/10.11…
@icmteaching @BJAJournals Is it possible that the authors were referring to SCLS? If yes, fluid resuscitation is one of the treatment options there