Portions of the current WHO guidelines regarding fluid management are dangerously misguided.

The first two recommendations suggest limiting fluid administration in patients with ARDS and patients who aren’t shocked, to avoid exacerbating pulmonary edema. These are sensible, evidence-based recommendations.

Notably, these recommendations apply well to patients with coronavirus, whose primary life-threat is ARDS.

Subsequent recommendations regarding “septic shock” slide off the rails.

First, septic shock is defined as anyone with a MAP <65 mm and lactate >2 mM in the absence of hypovolemia. Really? Septic shock is ultimately a clinical diagnosis which defies any one-line definition.

In the event of a coronavirus epidemic, a strategy which increases the rate of intubation would be highly problematic. Even in well-resourced countries, we could rapidly exhaust our supply of ICU beds and mechanical ventilators.

Not only is large-volume resuscitation poor care for any individual patient, but it could be catastrophic when leveraged across a patient population during an epidemic.

Read More