Transcriptions
Note: this content has been automatically generated.
00:00:00
thank you very much Christopher this
00:00:02
very very unclear and fascinating talk
00:00:04
with lots of thought-provoking
00:00:07
statements i'm sure there are many
00:00:10
questions are there any questions in the
00:00:12
audience i was telling us that
00:00:22
recognition is superior to to dopamine
00:00:26
yeah and then I probably mr. point that
00:00:28
then you tell us that we should use WT
00:00:32
norepinephrine well I think you should
00:00:35
we can use both depending on the on the
00:00:38
situation where you're in when you have
00:00:39
higher vascular resistance then you you
00:00:43
first need something to improve
00:00:45
myocardial contractility and sometimes
00:00:48
you it makes sense to use both the rumen
00:00:52
to increase positive inotropic support
00:00:54
norepinephrine to try trait the vascular
00:00:59
I think that's individual clinical that
00:01:00
judgment according to the hammer dynamic
00:01:02
situation a certain hour of like the
00:01:05
baby actually usually newborn babies
00:01:12
usually am especially gram-negative that
00:01:14
they have high peripheral vascular
00:01:15
resistance and if I don't hug you into
00:01:19
the club open on the weekend often given
00:01:24
cope to question if these are allowed
00:01:34
first regarding this million of study
00:01:37
and was million monotherapy or was it
00:01:40
our combined with another drop
00:01:44
well as I as far as i remember well in
00:01:48
India enterovirus that was monotherapy
00:01:50
the Vietnam trial
00:01:51
yes and in there india dose-finding
00:01:54
studies it was always add onto usually
00:01:59
ok and the second question
00:02:01
got the food management in sepsis you
00:02:04
said that we should be very close with a
00:02:07
adeboye char fluids and Drita under
00:02:11
echocardiographic our control and
00:02:13
cartography control and what is your
00:02:16
suggestion for the bases are free that
00:02:20
we're giving should we reduce the mass
00:02:22
play also we need 250 per kilo
00:02:26
how do you do that the basic solution
00:02:28
you're going well I i wouldn't change
00:02:30
the basic solution we just keep it
00:02:32
running and then add extra fluid
00:02:36
according to what you see in the echo
00:02:38
and if we see already that our heart is
00:02:43
over loaded with food
00:02:45
well then you should have then you then
00:02:46
of course you should use an eye drop but
00:02:49
you should do you would do always look
00:02:53
at the acting out i hope i think that
00:02:55
because you from the outside it's
00:02:56
difficult to tell
00:02:57
okay thank you very much
00:03:01
let's define it want to add a word of
00:03:04
caution and to make sure that not
00:03:06
everybody goes home using intoxicated
00:03:08
the moment because you have to look at
00:03:10
the numbers in exasperation small it's
00:03:12
the small studies and most of them are
00:03:14
from Poland you showed an example where
00:03:16
very few small studies short and
00:03:19
positive effect and then there was a
00:03:20
large RC done and the effect is gone so
00:03:22
controlling to publication bias and I
00:03:25
think we need a large country a study
00:03:27
but I i think it's very difficult to do
00:03:29
such as such a trial because overall
00:03:32
acceptance which meets extended
00:03:35
hemodynamic support is a rare we talked
00:03:39
a lot about this but most babies don't
00:03:41
have severe sepsis they came they
00:03:43
receive antibiotics a little bit of
00:03:44
sodium chloride and that's fine
00:03:46
so the severe sepsis is a rare if you
00:03:49
look at the apple trials even they had
00:03:51
to have recruited many many centers and
00:03:53
every Center just had two or three cases
00:03:56
which they added to their to the trial
00:03:59
and such a try is very very expensive
00:04:02
because you have to initiate so many
00:04:04
centers and I don't think that ever
00:04:08
it's such a trial will be financed at
00:04:11
least in in the lodge light in in
00:04:13
northern North America or Europe just
00:04:18
thank you very much i think you're right