I have always been puzzled by the fact that the Leadership of the sepsis community places “equal weight” on MAP and SBP...
MAP is obviously partly dependent on DBP which is not necessarily measured accurately using automated cuff BP measurement at least according to traditional korotkoff DBP definitions (especially at the lower end of DBP values ) (obviously using an A-line for DBP would give more reliable readings but most ED/ward pts dont have an A-line insitu) I personally don’t understand why/how we started down this slippery slope and why sepsis leadership didn’t focus our surveillance efforts on monitoring SBP and tissue perfusion deficits given that MAP = (2d +s) / 3 Or 1/3 Sbp plus 2/3 dbp Then 100/60=map 73 90/60 = map 70 90/50= map 63 90/40=57 Automated cuff DBPs are being given too much weight in my medical opinion... Respectfully Thomas Westover MD Cooper Medical School Camden NJ Sent from my iPhone > On Apr 25, 2018, at 6:19 PM, sepsisgroups-requ...@lists.sepsisgroups.org > wrote: > > Send Sepsisgroups mailing list submissions to > sepsisgroups@lists.sepsisgroups.org > > To subscribe or unsubscribe via the World Wide Web, visit > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > > or, via email, send a message with subject or body 'help' to > sepsisgroups-requ...@lists.sepsisgroups.org > > You can reach the person managing the list at > sepsisgroups-ow...@lists.sepsisgroups.org > > When replying, please edit your Subject line so it is more specific > than "Re: Contents of Sepsisgroups digest..." > > > Today's Topics: > > 1. Re: [External] Vasopressor administration (Mary Draper) > > > ---------------------------------------------------------------------- > > Message: 1 > Date: Fri, 20 Apr 2018 17:47:13 +0000 > From: Mary Draper <mary.dra...@johnmuirhealth.com> > To: Tara Miller <tara.mil...@infirmaryhealth.org>, > "'sepsisgroups@lists.sepsisgroups.org'" > <sepsisgroups@lists.sepsisgroups.org> > Subject: Re: [Sepsis Groups] [External] Vasopressor administration > Message-ID: > > <mwhpr08mb25259187e04c00b2533e40f990...@mwhpr08mb2525.namprd08.prod.outlook.com> > > Content-Type: text/plain; charset="us-ascii" > > We use BP < 90 and/or mean < 65. It doesn't have to be both. > > Mary Draper RN BSN > Coordinator Quality Improvement > Peer Review Support CV/CT > JMH Quality Management > Office (925) 674-2045 > Cell (925) 451-8792 > Fax (925) 674-2373 > mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com> > [cid:image002.png@01D3D894.F08F9F20] > "O, let us always have a mountain within our soul, with a peak so high that > we never quite reach the top... > For then we will always strive for greater things and will not be content > with merely climbing hills." Ardath Rodale > > From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On > Behalf Of Tara Miller > Sent: Thursday, April 19, 2018 7:39 AM > To: 'sepsisgroups@lists.sepsisgroups.org' > <sepsisgroups@lists.sepsisgroups.org> > Subject: [External] [Sepsis Groups] Vasopressor administration > > ________________________________ > Caution: This email originated outside JMH. Do not open attachments or click > on links if you do not recognize the sender. > ________________________________ > Is anyone having issues with patients who have persistent hypotension after > fluids defined as SBP < 90, but they still have a MAP of > or equal to 65 and > no vasopressors being ordered? My facility's vasopressor orders read to > initiate when the MAP is < 65. We have had two patients who did not meet that > criteria until after the 6 hour window was up for vasopressors. > > Are other facility's changing their practice to start pressors for SBP < 90? > > Thanks. > > Tara R Miller, RN > Team Leader, Quality Management > Mobile Infirmary Medical Center > Office: 435-5109 > Cell: 605-8270 > > [IH_Logo_20170609] > > Confidentiality Notice: This electronic message, including any attachments, > is for the sole use of the intended recipient(s) and may contain confidential > and privileged information. Any unauthorized review, use, disclosure or > distribution is prohibited. If you are not the intended recipient, you are > hereby notified that any disclosure, copying, distribution, or action taken > in reliance on the contents of this electronic message and/or any attachments > is strictly prohibited. This quality assurance document is for the use of > Infirmary Health and is prepared and maintained pursuant to Section 22-21-8 > of the 1975 Code of Alabama. 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