CVP may not be the best measurement but it is tool in the arsenal. Not everyone has the arterial line monitoring that is available to look at SVV, SV, CO/CI but this is a useful tool in place of the Swan that I haven't actually seen used in many years. Most younger ICU nurses I have spoken with have never been taught to set one up let alone use them to monitor hemodynamics. Technology has come a long way.
If you are looking for information please feel free to contact me offline Jeffrey R Hanlon RN Stamp Out Sepsis -----Original Message----- From: Andy Bourgeois <[email protected]> To: sepsisgroups <[email protected]> Sent: Fri, Feb 15, 2013 10:19 am Subject: [Sepsis Groups] Fwd: volume required There is a good recent review on various methods to measure cardiac output to assess fluid responsiveness: Marik, PE. Noninvasive Cardiac Output Monitors: A State-of the-Art Review. J Cardiothorac Vasc Anesth. 2013 Feb;27(1):121-34. http://www.jcvaonline.com/article/S1053-0770%2812%2900148-6/fulltext There is also good evidence that CVP does not predict fluid responsiveness well: Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008 Jul;134(1):172-8 http://journal.publications.chestnet.org/article.aspx?articleid=1085950 -Andy Andy Bourgeois, MD, FAAEM Simi Valley Hospital On Tue, Feb 12, 2013 at 6:17 AM, [email protected] <[email protected]> wrote: > > Fluid challenge is one of the most dificult things to do....sometimes you > just need 1 l of cristaloids on others you will use as much as 5 l.....as it > was mentioned above the clinical response is the goal....o others you will > need more tools like central venous pressure, svo2 > Even measure the diameter of inferior cava vein all these to estimate where > are you standing..... > Hope it helps > Juan pataro md > instituto argentino de riñon y transplante > > From my HTC Sensation 4G on T-Mobile. The first nationwide 4G network > > > ----- Reply message ----- > De: "Rich Levrault" <[email protected]> > Para: "sandeep varma" <[email protected]> > CC: "[email protected]" > <[email protected]> > Asunto: [Sepsis Groups] volume required > Fecha: dom., feb. 10, 2013 10:59 a. m. > > > Fluid should be given until it fails to produce a clinically appropriate > response. Pulmonary edema is sometimes a necessary evil. > > Sent from Rich's iPhone > > On Feb 9, 2013, at 1:15 AM, sandeep varma <[email protected]> wrote: > > hello all > i have a query regarding fluid volume requirement in sepsis. often have seen > blood pressure improvement after fluid bolus but only to see it fall back > after few minutes. the postulated theory behind this was leakage of given > fluid into interstitial causing intravascular depletion again. my concern is > that how much of fluid can be given this way? will this lead on to pulmonary > edema and interstitial edema without much helping in building up intra > vascular volume and aiding in stabilizing blood pressure? > sandeep varma > thriuvananthapuram > kerala > india > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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