I work in two hospitals here in Hermosillo (that's in México), in none of them i have access to ScvO2, we use intermitent measurment of lactate and venous saturation instead, venous blood is sampled from either neck or chest catheter, the goals are the same as those established in the SSC guidelines, but not everyone knows or follows the algorithm established in the guidelines, despite tris situation we usually have acceptable outcome.
In conlusion: i think that it doesn't matter if you choose to follow srictcly the alrgorithm or not, the only thing that really matters is the early identification of haemodynamic compromise, using lactate or central venous oxygen saturation. The earlier we start adequate haemodynamic support, the better the outcome of patients. El 20/12/2011, a las 10:19, Jeffrey R Hanlon RN <[email protected]> escribió: > And what did those healthcare professionals do before the protocol. They > applied what they knew and what they thought was best for the patient with > the information at hand. Once the protocol was developed it gave a consistent > model to follow that saved lives. I have watched it work on many occassions. > Each physician still has the ability to use his or her knowledge base and > experience to treat the patient but having a tested model that can be > initiated even by prehospital personnel will, in my humble opinion continue > to save the patients from an ever increasing killer. > The longer we continue to bicker and pick it apart the more people are going > to succumb to sepsis. We need to all be on the same page. > > Jeffrey R Hanlon RN > Stamp Out Sepsis > > > > > -----Original Message----- > From: [email protected] > To: Jeffrey R Hanlon RN ; sepsisteam ; Joan.Greene > Cc: sepsisgroups > Sent: Tue, Dec 20, 2011 6:22 am > Subject: RE: [Sepsis Groups] SSC guidelines > > Ron, I agree with you. It is not any individual part of the protocol that > makes the difference. It is early recognition, appropriate antibiotic and > fluid management altogether. In addition, the end goal must be tailored to > the individual patient. > > Jeffrey, protocols do not save lives, health care professionals do. > > Riad Cachecho,MD,MBA > Director of Trauma > Crozer Chester Medical Center > One Medical Center Boulevard > Vivaqua Pavillion, suite 440 > Upland, PA 19013 > 610-447-6090 > THIS EMAIL CONTAINS CONFIDENTIAL INFORMATION. ANY INFORMATION CONTAINED IS > USED FOR PEER REVIEW PURPOSES ONLY. > > From: [email protected] > [mailto:[email protected]] On Behalf Of Jeffrey R > Hanlon RN > Sent: Monday, December 19, 2011 10:27 PM > To: [email protected]; [email protected] > Cc: [email protected] > Subject: Re: [Sepsis Groups] SSC guidelines > > All I can say is the protocol has and continues to save lives! > > Jeffrey R Hanlon RN > Stamp Out Sepsis > > > > > -----Original Message----- > From: [email protected] > To: Joan Greene > Cc: sepsisgroups > Sent: Thu, Dec 15, 2011 3:46 am > Subject: Re: [Sepsis Groups] SSC guidelines > > Hi Joan, > > My views (for what they're worth): > > Key issue is ScvO2 as sole indicator of O2 delivery. Agree other modalities > of assessment of volume responsiveness and O2 delivery have equal or greater > role, but I believe answer lies in a colleciton of clinical information: > dangerous for anyone to run too fast with a single modality! > CVC is necessary for a majority of these patients for pressors/ tropes > anyway. The authors don't argue against CVC but against over-reliance on CVP > and ScvO2. Pragmatically, we need to build a larger picture: we assimilate > informaiton from multiple sources to build our picture > Slight concerns with article. It confuses septic shock with severe sepsis > which is not helpful or appropriate (see criteria fig 1). Referencing is > somewhat author-centric > > Summary: Don't let this hold you back. EDs get excited about EGDT and forget > the basics. Let's try not to get hung up on individual modalities (esp until > we have ARISE/ ProCESS/ ProMISe) but recognise and intervene quickly using > the monitoring strategies we have to hand and an assimilation of information. > Rivers' protocol is good- and prob better than random care- but no-one ever > suggested it was the ultimate answer! > > What do others think? > > kind regards > > Ron > > On Mon, Dec 12, 2011 at 4:37 AM, Joan Greene <[email protected]> wrote: > > Has anyone else received push-back in their early goal-directed therapy > protocols after the attached article was published? We recently implemented > the SSC guidelines for EGDT in our hospital by using a screening algorithm to > activate a sepsis response team. The response team follows the 6-hour > bundle. Now, we have some physicians who want to revisit the need for a > central line based on this article. 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 > > > -- > Dr Ron Daniels > > > Suspect Sepsis: save someone's life today. > > Sign our e-petition at http://epetitions.direct.gov.uk/petitions/19602 > > Fellow: NHS Improvement Faculty > Chair: Surviving Sepsis Campaign United Kingdom > Chair: United Kingdom Sepsis Group > Member of Congress: Global Sepsis Alliance > Survive Sepsis Programme Director > First Trustee: U.K Sepsis Trust > > > Twitter: @sepsisuk > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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