Hi Claudia,
Resistance to fluid resuscitation in the renal population and "hx of CHF" population is a common barrier to overcome in most organizations during the initial roll out of a sepsis program. The myth is that these populations will become fluid overloaded and require intubation. The reality is that these populations are often under-resuscitated and develop organ failure. Even if a patient was fluid overloaded and intubated secondary to resuscitation for sepsis related cryptic or overt shock, this is not what they die from. Sepsis patients die from organ failure. Using targeted resuscitation often results in adequate fluid resuscitation by decreasing reluctance to administer an appropriate fluid load. IF the CXR is clear, no JVD in a renal patient, let the fluids flow. Prevent a second organ failure (shock liver, DIC,...). If CVP is less than 8 mmHg, let the fluids flow. Septic shock is vasogenic, rarely leads to intubation in a non-pulmonary infection source in either population. I achieved buy-in from our renal service by monitoring the incidence of fluid overload requiring intubation in the ESRD patients whom the fluid load was administered per the guidelines. We quickly dispelled the belief that adequate resuscitation harmed the ESRD population. They became believers and would actually find me to discuss a patient in Med-surg that needed to come to ICU for...aggressive, targeted fluid resuscitation, who were on chronic hemodialysis. Good luck! Patty Cormack From: [email protected] [mailto:[email protected]] On Behalf Of Orth, Claudia Sent: Wednesday, March 05, 2014 12:32 PM To: [email protected] Subject: [Sepsis Groups] Sepsis Pearls for Nephrology Dear Colleagues, I am wondering if anyone would be willing to share a few pearls or talking points that might help me in speaking to one of our Nephrologists who is resistant to fluid resuscitating his renal patients that present in severe sepsis or shock. Any thoughts or words of wisdom would be very much appreciated. Respectfully, Claudia Claudia Orth, BSN, RN Sepsis Coordinator Munson Medical Center 1105 Sixth Street, Traverse City, MI 49684-2386 [email protected] 231-935-5692 PLEASE NOTE: The information contained in this electronic mail message is a Patient Safety Work Product for Quality Improvement & Peer Review - This Information is Privileged and Confidential and intended only for certain recipients. If you are not an intended recipient, you are hereby notified that any disclosure, reproduction, distribution or other use of this communication and any attachments is strictly prohibited. If you have received this communication in error, please notify the sender by reply transmission and delete the message without copying or disclosing it. This message (including any attachments) is confidential and intended solely for the use of the individual or entity to whom it is addressed, and is protected by law. If you are not the intended recipient, please delete the message (including any attachments) and notify the originator that you received the message in error. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. Any views expressed in this message are those of the individual sender, except where the sender specifies and with authority, states them to be the views of West Suburban Medical Center. This footer also confirms that this email message has been scanned for the presence of computer viruses.
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