Since both groups in ARISE did receive vasopressors, although usual care received marginally fewer applications, I don't think you can conclude they make no difference. You would have to assert that the small number who received fewer applications somehow had statistical significance and I'm sure that number is far too small. Plus that's a secondary analysis of a test not intended by the trial -- long and short, don't draw this false conclusion.
That said nobody really knows if vasopressors save lives in sepsis. Truth is really very simple -- most docs cannot stand to look at a BP of 70/40 and sit on it after a good fluid bolus fails. If you've got docs that feel comfortable doing that, I'd say they are daredevils unlike the average ED doc or intensivist! On Apr 23, 2015, at 7:17 AM, Jeanie Bollinger <[email protected]<mailto:[email protected]>> wrote: Hello group, I have a question on the CMS bundle and the revised SCCM guidelines concerning volume resuscitation and application of vasopressors. The 3 hours bundle states fluid 30ml/kg for hypotension or lactate >4. The 6 hour bundle states to apply vasopressors for hypotension that does not respond to initial fluid resuscitation. Is the recommendation to add vasopressor after 30ml/kg or can the provider give more fluid and then within the 3-6 hour window then apply vasopressors for sustained hypotension? There is discussion among our team referring to the ARISE trial and that the variable of vasopressor therapy did not change outcomes. Any insight on the perspective of others is appreciated. Jeanie Bollinger Jeanie Bollinger MSN,RN,ACCNS-AG, CCRN Sepsis Clinical Nurse Specialist Nursing Department of Excellence Mission Health Asheville, NC Phone: 828-213-7171 Beeper: 828-207-2363 ________________________________ ________________________________ This message and its attachments may contain confidential and/or legally-sensitive information that is intended for the sole use of the addressee(s). Any unauthorized review, use, disclosure, or distribution of the information contained in this message and its attachments is prohibited. If you have received this message or any of its attachments in error, please destroy all originals and copies of the same and notify the sender immediately. _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[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
