This is the same stance we are taking at our facility with physicians. We also
include it is easier to treat one organ failure then multiple organ failure
when a patient does not receive adequate fluid response. Providing the
research and data to support this is pertinent. We have two physician drivers
in the ED and ICU who are championing this, and it has increased our fluid
compliance in CHF and ESRF patients.
Erin K. Parker RN, BSN, ACM | Infection Control
Genesys Regional Medical Center | One Genesys Parkway | Grand Blanc, MI 48439
Phone: 810.606.5093| Fax: 810-606-5495 |
[email protected]<mailto:[email protected]> |
www.genesys.org<http://www.genesys.org/>
From: Sepsisgroups [mailto:[email protected]] On
Behalf Of Kathryn Tucker
Sent: Monday, August 08, 2016 1:32 PM
To: 'Haywood, Pamela'; Pender.Linda; '[email protected]'
Subject: Re: [Sepsis Groups] 30 cc's/kg
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/<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.ncbi.nlm.nih.gov_pmc_articles_PMC4057360_&d=CwMFAg&c=Rm3hRyxmymJgpBTCyRDm7Q&r=8-E7F-O-Pm6NE44jMi1aQwcxddU1g1ah_mGZhj_sXTE&m=2UDUMVYE_eEttww4JjxGbFxaSMChM90eWNMYJGc6v1c&s=wTag6HDKXcZIIk0nkpxOaaQU8in7vyUuOmvU4_0d-Qw&e=>
* 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]<mailto:[email protected]>>;
'[email protected]'
<[email protected]<mailto:[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
[MCCG...World Class Care! See our
website...]<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=>
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