Looking for clarification:
  In order to meet the CMS "persistence hypotension" definition the patient 
must have two recorded pressures to reflect hypotension.  We have had patients 
that required vasopressor support even after the 30 mL/kg.  It goes without 
saying that as a critical care nurse you are constantly attempting to wean 
vasopressor support.  Our guidelines for weaning vasopressor support is to keep 
the MAP >65 and SBP > 90.  In addition to the 30ml/kg NS or LR we have 
additional bolus for CVP/MAP if needed.  I do not believe it is wise to allow 
your septic shock patient to remain hypotensive for the sake of meeting the 
measure.  But it doesn't seem logical to exclude a patient from the septic 
shock portion of the measure because they continued to require vasopressor 
support for adequate systemic perfusion.  What are you doing at your facility?
Rebecca Garner R.N.Sepsis Coordinator Conroe Regional Medical Center 
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