As stated in other responses, cardiac dysfunction, manifested as low CO or low EF, is a reason TO give fluid, not withhold it. The new guidelines will now allow for the 30ml/kg "bolus" to be completed by end of hour 3. That sounds judicious to me. That said, to echo an earlier comment, it is much easier to treat pulmonary congestion from early fluid resuscitation than it is to treat late multi-organ failure from lack of resuscitation.
Thanks, Mary Ann Daly, RN BSN CCRN DC Regional Clinical Initiative Lead-Sepsis and ICU Liberation (ABCDE) Gordon and Betty Moore Foundation Grant Sutter Health Sacramento Sierra Region E-mail: [email protected]<mailto:[email protected]> Blackberry: 916.200.5604 Office: 916.614.6370 From: [email protected] [mailto:[email protected]] On Behalf Of Mulligan, Ann W. Sent: Friday, August 17, 2012 9:14 AM To: Sepsis list group ([email protected]) Subject: [Sepsis Groups] Heart failure patients presenting with sepsis Our hospital continues to struggle with meeting the fluid bolus requirements when a CHF patient with a low EF presents with sepsis. Cardiology is suggesting that ED perform a bedside ECHO if the patient has CHF and/or know reduced ejection fraction, and to be prudent when giving several liters of fluid. How are other hospitals approaching these patients, and what is the latest guidelines for sepsis treatment within this diagnosis? Ann Mulligan, RN, BSN, CPHQ Manager Quality & Outcomes Alta Bates Summit Medical Center 2450 Ashby Ave. Berkeley, CA 94705 Ph: (510) 204-2986 Fax: (510) 204-1221 Cell: (510) 325-4044 [email protected]<BLOCKED::mailto:[email protected]> Confidential Notice: This email is for the sole use of the intended recipient and may contain material that is confidential and protected by state and federal regulations. If you are not the intended recipient please immediately delete it and contact the sender. Thank you.
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