Our intensivist has taken the position that you cannot resuscitate dead. When providers argue that the 30 cc/kg is too much for a CHF patient, he "tactfully" reminds the providers that we need a live patient to treat the CHF. If you don't provide adequate fluid resuscitation, you don't have to worry about fluid overload. We know that the sepsis mortality rate was 40% before the recent focus on sepsis care and bundled treatment.
Try giving them the evidence. I try to find a good study that is on point for their concern. They may review the evidence and reach their own conclusions. If they still pushback, ask them to share their studies (evidence) so that you can learn. If they do not have the evidence to back their assertion that 30 cc/kg is too much in a CHF patient, it makes it much more difficult to justify failure to follow internationally accepted standards. The study referenced below (2014) found that patients with left ventricular dysfunction had similar outcomes to patients without CHF. Comparison of outcomes from sepsis between patients with and without pre-existing left ventricular dysfunction: a case-control analysis. Ouellette DR, Shah SZ Patients with sepsis and pre-existing left ventricular dysfunction have similar outcomes when compared to patients with sepsis with normal pre-existing left ventricular function. *Patients with pre-existing left ventricular dysfunction who suffer from sepsis may be no more likely than patients with normal left ventricular function and sepsis to develop respiratory compromise when treated aggressively with intravenous fluids. *Patients with pre-existing left ventricular dysfunction who develop sepsis have different mortality risk factors than other patients. Mortality risk factors are related to oxygen delivery variables in these patients. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057360/ * Crit Care. 2014 Apr 23 ;18(2):R79. doi: 10.1186/cc13840. Kathy From: Sepsisgroups [mailto:[email protected]] On Behalf Of Haywood, Pamela Sent: Friday, August 05, 2016 12:45 PM To: Pender.Linda <[email protected]>; '[email protected]' <[email protected]> Subject: Re: [Sepsis Groups] 30 cc's/kg Many concerns from our providers regarding patients with HTN and CHF history. Pamela J Haywood, BSN, RN Clinical Documentation Specialist Jones Memorial Hospital 191 N Main St Wellsville, NY 14895 585-593-1100 ext 5209 ________________________________ From: Sepsisgroups [[email protected]] on behalf of Pender.Linda [[email protected]] Sent: Tuesday, August 02, 2016 13:52 To: '[email protected]' Subject: [Sepsis Groups] 30 cc's/kg How are you all working with your physicians to encourage the use of 30cc's/kg? Especially in CHF and Renal patients? Linda G. Pender RRT-NPS Sepsis Coordinator Patient Care Services Administration phone: 478-633-6806 pager: 4444 KNOW Sepsis: Inside & Out [cid:[email protected]]<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.navicenthealth.org_&d=DQMF-g&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA&r=r9TCrDIO6gDxR5pVxvLp6ZMJGAIAi5mk7P1ps_740bbyThcvO6h4qg7bxcQGH6s1&m=QJGhaGGDMwUO_spzQrD0FIxkcVEU-pxIi9S4deANjUE&s=C52w6i7PkLTrbwjLZtzCRfx9DycaiSwIr0KtvxOYefs&e=> Email: [email protected]<mailto:[email protected]> CONFIDENTIALITY NOTICE: The information transmitted in this e-mail message, including any attachments, is for the sole use of the intended recipient(s) or entity to which it is addressed and may contain confidential, privileged, and/or proprietary information. Any unauthorized review, retransmission, use, disclosure, dissemination, or other use of, or taking any action in reliance upon this information by persons or entities other than the intended recipient is prohibited. If you are not the intended recipient, you are hereby notified that any reading, dissemination, distribution, copying, or other use of this message or its attachments is strictly prohibited. If you have received this message in error, please notify the sender immediately by reply e-mail, or by calling (478) 633-7272, and destroy the original message, attachments, and all copies thereof on all computers and in any other form. Thank you. Navicent Health. http://www.navicenthealth.org/<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.navicenthealth.org_&d=DQQF-g&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA&r=r9TCrDIO6gDxR5pVxvLp6ZMJGAIAi5mk7P1ps_740bbyThcvO6h4qg7bxcQGH6s1&m=QJGhaGGDMwUO_spzQrD0FIxkcVEU-pxIi9S4deANjUE&s=C52w6i7PkLTrbwjLZtzCRfx9DycaiSwIr0KtvxOYefs&e=>
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