Hello again, I have 2 questions regarding the new measure updates presented at the last webinar "Early Management Bundle, Severe Sepsis/Septic Shock Part III" on Oct. 26.
1. I see the definition for persistent hypotension is defined as 2 consecutive BP readings of hypotension. Is the same true to define hypotension for organ dysfunction with severe sepsis. Is more than 1 low BP required to trigger the need for the 30ml/kg fluid bolus or is 1 low BP enough to treat? 2. The bolus rate of infusion was clarified as >125ml/hr. Is this correct? Most fluid boluses of 30ml/kg are between 2,000-3,000ml total volume. At slower bolus rates of 200-250ml/hr the infusion times could be well over 6hrs. This would exclude patients from the septic shock measure as the shock start time could not be determined until after the fluid bolus is completed. Example: 75kg patient presents with severe sepsis with hypotension at 12:00. Fluid bolus 2,250ml ordered at 250ml/hr. Bolus hung at 12:30 and completed at 21:30. Assessed for persistent hypotension between 21:30 and 22:30 which is > 6hrs after severe sepsis presentation excluding pt from the septic shock measure. I would hope if the patient was severely hypotensive that fluids would be given at a much faster rate, but even with rates at 500ml/hr the total bolus completion time could exceed the 6 hr time from severe sepsis presentation. I have been educating the medical staff to order the boluses over 1-3 hrs but many will be thrilled to know they can order slower rates of infusion as there is still fear of sending patients into CHF. I just want to be certain I am understanding this correctly. Also, in the presentation on Oct 26, slide 3/3 for Crystalloid Fluid Administration the last bullet point stated that "Total volume (30ml/kg) does not need to be completely infused". I missed the explanation of this point. Can anyone comment? Thank you, Brenda Prabhakar RN BSN Sepsis Steering Committee Co-Chair Doylestown Hospital Doylestown, PA
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