So welcome back to the Internet Book of Critical Care podcast.

I'm here with Adam Thomas and we're going to talk about resuscitated fluid selection.

All right, peeps, this is going to be one of my favorite podcasts we've had.

It took us 42 to get here, but this is fluid selection and pH-guided resuscitation. Today we'll talk about

step one, choosing your fluids. Step two, pH-guided fluid resuscitation, and then a hodgepodge

of juicy, juicy clinical pearls to get you through your days as reanimators. So Josh, start us off.

Why is it important what fluid we choose? And why do people

argue that maybe one or two liters is not a big problem? So if you think about what drives

change in medicine, I think it's horrific things that happen with a reasonable frequency. So if

things aren't like really awful, then if they fall underneath like a certain

frequency, nobody cares about them. And I think that's the problem with fluids, which is that

they sometimes cause problems, but usually they're not obvious problems and the obvious problems

occur relatively and frequently. So there's not a big driver to change. And we'll talk about the

salty D trial, but Josh, I think what you're getting at here is the compounding effect that if the

number needed to treat is 30 or 50, we can find easily 30 or 50 patients around us that are getting

volume every day. So in a hospital-based system with 700 patients, that is a huge effect for the

entire population. Exactly. And the difference between all these fluids is really

minimal as far as cost or logistics. So I think it makes sense to choose the best one. Now let's move on

to crystalloids versus colloids. Just like the other quintessential critical care debates of steroids,

of modes of ventilation. Let's get down to when do we pick a crystalloid, when

to be pick a colloid, when do we sneak that albumin in there? I think long story, super

short. There's evidence to support the use of albumin in spontaneous spectral pertinitis,

...