Hi Joan, My views (for what they're worth):
- Key issue is ScvO2 as sole indicator of O2 delivery. Agree other modalities of assessment of volume responsiveness and O2 delivery have equal or greater role, but I believe answer lies in a colleciton of clinical information: dangerous for anyone to run too fast with a single modality! - CVC is necessary for a majority of these patients for pressors/ tropes anyway. The authors don't argue against CVC but against over-reliance on CVP and ScvO2. Pragmatically, we need to build a larger picture: we assimilate informaiton from multiple sources to build our picture - Slight concerns with article. It confuses septic shock with severe sepsis which is not helpful or appropriate (see criteria fig 1). Referencing is somewhat author-centric *Summary*: Don't let this hold you back. EDs get excited about EGDT and forget the basics. Let's try not to get hung up on individual modalities (esp until we have ARISE/ ProCESS/ ProMISe) but recognise and intervene quickly using the monitoring strategies we have to hand and an assimilation of information. Rivers' protocol is good- and prob better than random care- but no-one ever suggested it was the ultimate answer! What do others think? kind regards Ron On Mon, Dec 12, 2011 at 4:37 AM, Joan Greene <[email protected]> wrote: > Has anyone else received push-back in their early goal-directed therapy > protocols after the attached article was published? We recently > implemented the SSC guidelines for EGDT in our hospital by using a > screening algorithm to activate a sepsis response team. The response team > follows the 6-hour bundle. Now, we have some physicians who want to > revisit the need for a central line based on this article. The bundle > cannot be followed without a central line to measure the CVP and/or ScvO2 > monitoring. I would appreciate any comments. Thank you. > > Joan Greene > San Diego > -- Dr Ron Daniels *Suspect Sepsis: save someone's life today.* * * *Sign our e-petition at **http://epetitions.direct.gov.uk/petitions/19602* * * Fellow: NHS Improvement Faculty Chair: Surviving Sepsis Campaign United Kingdom Chair: United Kingdom Sepsis Group Member of Congress: Global Sepsis Alliance Survive Sepsis Programme Director First Trustee: U.K Sepsis Trust *Twitter: @sepsisuk*
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