IV Fluids and Glucocorticoids for Sepsis with Dr. Kathryn Hibbert


The March 1, 2018 issue of the NEJM was packed with new evidence to help residents better care for their patients. A pair of papers compared balanced intravenous solutions with normal saline while another pair revisits the question of are glucocorticoids beneficial for septic shock. In this interview, Dr. Kathryn Hibbert reviews the biology underlying the effects of various fluids on the body and how sepsis disrupts the body’s natural response to corticosteroids. We also discuss the major points from these four new papers and existing literature to get you up to speed on the evidence behind practice.

00:00 introduction
02:52 start of section on IV fluids
04:01 colloids vs. crystalloids
10:00 crystalloids and balanced solutions vs. saline
13:59 SMART and SALT-ED trials
22:51 cautions about giving fluids
26:17 start of section on glucocorticoids for sepsis
26:40 existing evidence
28:08 biology of glucocorticoids in sepsis
32:16 ADRENAL and APROCCHSS trials
42:49 summary and concluding remarks
46:31 credits

This podcast is part of the series, Curbside Consults, which complements the foundational information in Rotation Prep by taking a deep dive into key topics with expert clinicians and educators. As we explore the details of pathophysiology and critique the evidence behind clinical practice, these conversations are intended to give you better understanding of the topic and greater confidence when treating your patients.

Dr. Hibbert is an Instructor in Medicine at Harvard Medical School, Director of the MGH Medical Intensive Care Unit, and Site Director for the Harvard Pulmonary and Critical Care fellowship. She is also the MGH site PI for the NHLBI Prevention and Early Treatment of Acute Lung Injury (PETAL) Clinical Trials Network. She has won multiple teaching awards and is currently completing a Harvard Rabkin Fellowship looking at the integration of physiology into clinical decision making in critical illness.

Mike Mi is a 2017-2018 NEJM Editorial Fellow and a hospitalist at Beth Israel Deaconess Medical Center. He graduated from Harvard Medical School and completed his internal medicine training at BIDMC.