The sepsis guidelines state that fluid resuscitation should be 30mL/kg. Is there literature out there that supports less fluids?
Teresa Gomez [email protected] -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Friday, May 30, 2014 8:10 AM To: [email protected] Subject: Sepsisgroups Digest, Vol 111, Issue 5 Send Sepsisgroups mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org or, via email, send a message with subject or body 'help' to [email protected] You can reach the person managing the list at [email protected] When replying, please edit your Subject line so it is more specific than "Re: Contents of Sepsisgroups digest..." Today's Topics: 1. Re: Fluid Bolus in pts. with weight > 200 kg (Barnes-Daly, Mary Ann) 2. Re: Sepsisgroups Digest, Vol 110, Issue 3 (Barnes-Daly, Mary Ann) 3. Re: Fluid Bolus in pts. with weight > 200 kg (Kramer, George C.) ---------------------------------------------------------------------- Message: 1 Date: Thu, 29 May 2014 15:18:37 -0700 From: "Barnes-Daly, Mary Ann" <[email protected]> To: "'Kelsey K. Solano'" <[email protected]>, "'[email protected]'" <[email protected]> Subject: Re: [Sepsis Groups] Fluid Bolus in pts. with weight > 200 kg Message-ID: <62b84847cb93ba4fbe626d1b1d6d6e430137cbef4...@dcbl105vx.root.sutterhealth.org> Content-Type: text/plain; charset="us-ascii" Every recommendation that I have seen or heard, most recently from the faculty on the SSC, is to go with actual body weight. Remembering that adipose tissue is highly vascular and contains a large amount of water and that the main 2 reasons for the fluid bolus are 1. Vasodilation reducing perfusion pressure and more importantly 2. Capillary leaking - and with all those miles (literally) of leaky capillaries obese patients have a very high propensity for intravascular volume depletion. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Kelsey K. Solano Sent: Wednesday, May 28, 2014 7:05 AM To: [email protected] Subject: [Sepsis Groups] Fluid Bolus in pts. with weight > 200 kg I am wondering whether there are any recommendations regarding fluid resuscitation in patients weighing >200 Kg? Our physicians have expressed concern about the recommended fluid bolus for patients who are > 200 Kg and potential for CHF exacerbations. Are there any resources that address this concern or any modifications for this patient population? Also, is it always recommended to go with 30 ml/kg based on current weight or should we be calculating ideal weight when determining bolus volume? Currently we are using the patient's actual weight on admission for bolus calculations. Any clarifications regarding the fluid bolus would be greatly appreciated. Thanks, Kelsey K. Solano Sepsis Coordinator Email: [email protected]<mailto:[email protected]> Office: 574-335-2438 -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140529/9f1940e9/attachment-0001.htm> ------------------------------ Message: 2 Date: Thu, 29 May 2014 10:31:38 -0700 From: "Barnes-Daly, Mary Ann" <[email protected]> To: "'Brochis, Dale.'" <[email protected]>, 'Daniel Gerard' <[email protected]>, "'[email protected]'" <[email protected]> Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 110, Issue 3 Message-ID: <62b84847cb93ba4fbe626d1b1d6d6e430137cbef4...@dcbl105vx.root.sutterhealth.org> Content-Type: text/plain; charset="iso-8859-1" Not sure about the DNR cohort reference. These patients should receive full care unless refused. -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Brochis, Dale. Sent: Wednesday, May 28, 2014 5:54 AM To: Daniel Gerard; [email protected] Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 110, Issue 3 This same perspective applies to calculation of mortality rates. We need a clear, non-modifiable way to capture mortality that is consistent across all organizations, while including ways to identify DNR, hospice modifiers. Dale Brochis BA Gainsharing Project Coordinator Case Management Department Robert Wood Johnson University Hospital?at Rahway 865 Stone Street Rahway, NJ 07065 732-499-6217 Office / 732-428-2108 Cell [email protected] -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Daniel Gerard Sent: Tuesday, May 27, 2014 1:32 PM To: [email protected] Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 110, Issue 3 Re: timing of Blood cultures. I agree with Terry. The same philosophy applies for all the measures we collect. The data is strongest by being consistent. Some sites "exclude" certain patients from data collection. The more site specific criteria that goes into the database that do not follow the "rules" the less valid the total numbers. It does help to find "failures" that is what drives system improvements Daniel Gerard RPh Critical Care Pharmacist McClaren-Northern Michigan Phone: 231-487-4770 FAX: 231-487-4817 [email protected] -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Friday, May 23, 2014 4:19 PM To: [email protected] Subject: Sepsisgroups Digest, Vol 110, Issue 3 Send Sepsisgroups mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org or, via email, send a message with subject or body 'help' to [email protected] You can reach the person managing the list at [email protected] When replying, please edit your Subject line so it is more specific than "Re: Contents of Sepsisgroups digest..." Today's Topics: 1. Re: Sepsisgroups Digest, Vol 109, Issue 1 (Terry Clemmer) ---------------------------------------------------------------------- Message: 1 Date: Thu, 22 May 2014 13:54:33 +0000 From: Terry Clemmer <[email protected]> To: "Dierks, Patricia" <[email protected]>, "'[email protected]'" <[email protected]> Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 109, Issue 1 Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" I personally feel strongly that once in place you should stick by the rules. If blood cultures should be done prior to antibiotics and they were not then the criteria was not met. There are many reasons they may not be met, some legitimate some not. Because there are always some legitimate reasons I am always skeptical of reports of 100% compliance. That usually means the system is being gamed by finding ways to excluding the "legitimate reasons" for not complying. The problem is that the interpretation of "legitimate reasons" do not have rules around them and they become substitute excuses with huge variation from data collector to data collector until the database becomes useless. Unless there are specific rules around a situation (like emergency surgery taking priority) that is standard and used by everyone doing the data collection, then a failure is a failure. Clearly the reason we play this excuse game is to look better or meet a goal. Remember in making the system better it is the failures that push us forward. Would it not be better to develop a system in which in the future patients going to surgery emergently would always get the cultures done rather than using this as a precedence to not do them in the future? Terry P. Clemmer, MD Director: Critical Care Medicine LDS Hospital Professor of Medicine University of Utah School of Medicine Salt Lake City, Utan 84143 Work Phone: 801-408-3661 Work Fax: 801-408-1668 -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Dierks, Patricia Sent: Wednesday, May 21, 2014 12:21 PM To: '[email protected]' Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 109, Issue 1 I would recommend sending blood cultures anyway. What if the offending organism happens to be resistant to usual antibiotics? Just to be safe... -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Monday, May 12, 2014 2:11 PM To: [email protected] Subject: Sepsisgroups Digest, Vol 109, Issue 1 Send Sepsisgroups mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org or, via email, send a message with subject or body 'help' to [email protected] You can reach the person managing the list at [email protected] When replying, please edit your Subject line so it is more specific than "Re: Contents of Sepsisgroups digest..." Today's Topics: 1. Blood culture timing question (Reidford, Tammy) ---------------------------------------------------------------------- Message: 1 Date: Fri, 9 May 2014 19:32:39 +0000 From: "Reidford, Tammy" <[email protected]> To: "[email protected]" <[email protected]> Subject: [Sepsis Groups] Blood culture timing question Message-ID: <a16169235fc1ff4f80db47c5a050fc04035...@tx1p03dag0402.apptixhealth.net> Content-Type: text/plain; charset="us-ascii" I am asking input from others on behalf of one of our hospital sepsis champion on meeting the culture deadline for data extraction. A patient was sent to the ER from a physician's office with a prior outpatient CT showing colitis and was diagnosed with sepsis. Since the physicians already knew the source, the patient was sent emergently to OR for source control/colon resection without blood cultures. Does this affect how question 5 on whether a blood culture was sent? Thanks in advance for your input. Tammy Reidford, RN, CCDS Clinical Documentation Specialist Phone 812-485-6543 Pager 812- 428-1274 [email protected] CONFIDENTIALITY NOTICE: This email message and any accompanying data or files is confidential and may contain privileged information intended only for the named recipient(s). If you are not the intended recipient(s), you are hereby notified that the dissemination, distribution, and or copying of this message is strictly prohibited. If you receive this message in error, or are not the named recipient(s), please notify the sender at the email address above, delete this email from your computer, and destroy any copies in any form immediately. Receipt by anyone other than the named recipient(s) is not a waiver of any attorney-client, work product, or other applicable privilege. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140509/bc757876/attachment.html> ------------------------------ Subject: Digest Footer _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ End of Sepsisgroups Digest, Vol 109, Issue 1 ******************************************** _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ Subject: Digest Footer _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ End of Sepsisgroups Digest, Vol 110, Issue 3 ******************************************** Confidentiality Notice: This e-mail message, including any attachments, may contain confidential information. The information is intended only for the use of the individual(s) or entity named above. If you are not the intended recipient, you are notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this e-mail information is prohibited. If you have received this e-mail in error, please contact the sender by reply e-mail and destroy all copies of the original message. _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org This e-mail and any files transmitted with it are confidential and are intended solely for the use of the individual or entity to whom they are addressed. This communication represents the originator's personal views and opinions, which do not necessarily reflect those of Robert Wood Johnson University Hospital at Rahway. If you are not the original recipient or the person responsible for delivering the e-mail to the intended recipient, be advised that you have received this e-mail in error, and that any use, dissemination, forwarding, printing, or copying of this e-mail is strictly prohibited. If you receive this email in error, please immediately notify [email protected]. _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ Message: 3 Date: Thu, 29 May 2014 18:30:17 +0000 From: "Kramer, George C." <[email protected]> To: "Kelsey K. Solano" <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Fluid Bolus in pts. with weight > 200 kg Message-ID: <cface4bf.16ca2%[email protected]> Content-Type: text/plain; charset="us-ascii" Kelysey, A physiologist's perspective. If the patient is Type O - Obese then the 30 ml/kg bolus is excessive. And perhaps ideal wt is better, although lean body mass is what is really needed. And you can not measure that in the ED. Type F- Fit 200Kg, NFL linebacker, Navy SEAL, then 30 ml/kg is appropriate. Not necessarily because they have a stronger heart, but because their weight is roughly proportional to their blood volume, cardiac output, etc. Again true lean body mass would work. Since most patients are more type 1, then the tendency would be to fix the formula at Ideal weight. But don't be afraid to treat the large fit person with larger volumes. g From: "Kelsey K. Solano" <[email protected]<mailto:[email protected]>> Date: Wednesday, May 28, 2014 9:04 AM To: "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>> Subject: [Sepsis Groups] Fluid Bolus in pts. with weight > 200 kg I am wondering whether there are any recommendations regarding fluid resuscitation in patients weighing >200 Kg? Our physicians have expressed concern about the recommended fluid bolus for patients who are > 200 Kg and potential for CHF exacerbations. Are there any resources that address this concern or any modifications for this patient population? Also, is it always recommended to go with 30 ml/kg based on current weight or should we be calculating ideal weight when determining bolus volume? Currently we are using the patient's actual weight on admission for bolus calculations. Any clarifications regarding the fluid bolus would be greatly appreciated. Thanks, Kelsey K. Solano Sepsis Coordinator Email: [email protected]<mailto:[email protected]> Office: 574-335-2438 -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140529/20b92cda/attachment.htm> ------------------------------ Subject: Digest Footer _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ End of Sepsisgroups Digest, Vol 111, Issue 5 ******************************************** _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
