Joan I think you are seeing the beginning of a transition from using a CVP measurement that is only a surrogate for ventricular volume and function and which we have all recognized for decades was frequently unreliable, to newer methodology which were not easily and non-invasively available in the past that allows us to ask the more pertinent questions "Does more fluid improve the cardiac output?" and "when should I stop giving more fluid to avoid harm?". Currently unlike the CVP and ScvO2 this technology is not available in most institutions but as more scientific papers validate its usefulness it will become more popular and my prediction (and I have been wrong before so be careful) is that we will most likely transition to these newer concepts as we validate them and the technology becomes more routine.
I hope we do not make the error we made with the PA catheter and make it a standard of practice without anyone heading the 1985 advice of Eugene D. Robin MD that scientific validation of risk and benefit be preformed (Ann Intern Med. 1985 Sep;103(3):445-9. The cult of the Swan-Ganz catheter. Overuse and abuse of pulmonary flow catheters). It is sad that it took 30 years of misuse before we did the studies. Let's take the new opportunity and while there is still equipoise and scientifically demonstrate its benefit and potential harm before we make it a cult also. Terry P. Clemmer, MD Director of Critical Care Medicine LDS Hospital 8th Ave and 'C' Street Salt Lake City, Utah 84143 Phone 801-408-3661 E-mail: [email protected] "Confidential Report for Improvement of Hospital, Facility and Patient Care--Not Part of Medical Record and Not to be Used in Litigation--Prepared Pursuant to Utah Code Ann. § 26-25-1 et seq., or Idaho Code Ann. § 39-1392 et seq." -----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of Joan Greene Sent: Sunday, December 11, 2011 9:43 PM To: [email protected] Subject: [Sepsis Groups] FW: SSC guidelines Hello, Has anyone else received push-back in their early goal-directed therapy protocols after the attached article was published? The bundle cannot be followed without a central line to measure the CVP and/or ScvO2 monitoring. I would appreciate any comments. Thank you. Joan Greene San Diego _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
