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BET 2: Which fluid (colloids or crystalloids) is better in initial resuscitation of severe sepsis?

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Report by: Chamika R Mapatuna, FTSTA ACCS2 Intensive Care Medicine

Search checked by: Jasmeet Soar, Consultant Intensive Care Medicine

Institution: Anaesthetics Department, Southmead Hospital, North Bristol NHS Trust, Bristol

Clinical scenario

A 67-year-old woman presents to the Emergency Department (ED) with a 3-day history of a dysuria, nausea, vomiting and fever with rigours. She is confused and looks pale. Her respiratory rate is 40/min, heart rate is 120/min, blood pressure is 80/40 mm Hg and temperature is 38.9°C. You diagnose severe sepsis secondary to a urinary tract infection. You wonder whether crystalloids or colloids are best in the initial fluid resuscitation to improve her survival.

Three-part question

In (adult patients with severe sepsis), should (colloids or crystalloids be used for initial resuscitation) to (improve survival).

Search strategy

Medline 1960—09/2008 using NLH 2.0 Advanced Search.

({(exp sepsis) AND (early.ti.ab OR initial.ti.ab AND management.ti.ab OR resuscitation.ti.ab)} AND {(crystalloid$.af OR saline.af OR hartmann's.af OR ringer-lactate.af) AND (colloid$.af OR starch.af OR dextran.af OR gelatine.af OR albumin.af)}) AND Limit to humans, adults, …

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