All the more reason we should all try to have endpoints for resuscitation
right? Using Stroke Volume Optimization in these patients is very helpful!!
Give until the CI and SV have less than a 10% response in 10-15 minutes then
the thought that once they quit responding they are on the upper part of their
frank starling curve.
Anyone else using more dynamic numbers to tailor fluid optimization?
Angela Craig APN, MS, CCNS
CNS for ICU
Cookeville Regional Medical Center
931-783-5035
A Clinical Nurse Specialist (CNS) is a Master's prepared Advance Practice
Nurse whose function is to improve outcomes in patient care. The CNS is a
clinical practice expert, an educator, a researcher, and a consultant who
influences the three spheres of practice: patient care, nursing, and
systems. - National Association of Clinical Nurse Specialists
________________________________
From: [email protected]
[[email protected]] On Behalf Of
[email protected] [[email protected]]
Sent: Wednesday, October 02, 2013 2:09 PM
To: [email protected]; [email protected];
[email protected]
Cc: [email protected]; [email protected]
Subject: Re: [Sepsis Groups] fluid resuscitation in CHF or renal patients
please remove me from this email correspondence,
-----Original Message-----
From: Terry Clemmer <[email protected]>
To: Tracey Helmick <[email protected]>; sepsisgroups
<[email protected]>
Cc: narmstrong <[email protected]>; thelmick <[email protected]>
Sent: Wed, Oct 2, 2013 2:42 pm
Subject: Re: [Sepsis Groups] fluid resuscitation in CHF or renal patients
Do not omit them. They need the fluid if they have hypotension or lactate
greater than 4.0. Evidence is now available that fewer will end up on
ventilators if they get adequate initial resuscitation, they will have less
renal failure and dialysis if they get adequate initial fluid resuscitation.
Remember, of 1000 ml of NS only 250 ml stays intravascular. Most septic
patients are vasodilated and frequently dehydrated and need fluid. Not giving
fluid is dangerous, it increases mortality and is only treating physician fear,
not the patient.
Terry P. CLemmer, MD Director of Critical Care Medicine
LDS Hospital
Salt Lake City, Utah 84143
Professor of Medicine
University of Utah School of Medicne
Salt Lake City, Utah 84143
Phone: 801-408-3660
Fax: 801-408-1668
[email protected]<mailto:[email protected]>
From:
[email protected]<mailto:[email protected]>
[mailto:[email protected]<mailto:[email protected]?>]
On Behalf Of Tracey Helmick
Sent: Tuesday, October 01, 2013 12:41 PM
To:
[email protected]<mailto:[email protected]>
Cc: [email protected]<mailto:[email protected]>;
[email protected]<mailto:[email protected]>
Subject: [Sepsis Groups] fluid resuscitation in CHF or renal patients
Our institution continues to monitor and assess our Sepsis patient data. We
are having difficulty meeting the new 30ml/kg recommendations for fluid
resuscitation. We are finding that some of our outliers are the patients with
CHF or renal failure. Is this a common barrier and if so, what are other
institutions doing to assure those patients are receiving adequate fluid
resuscitation without causing harm to the patient? Should we omit those
patients from our data collection?
Respectfully,
Tracey Helmick RN, CCRN
Meadville Medical Center
MMC Severe Sepsis Team Nurse Champion
[email protected]<mailto:[email protected]>
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