Hi Kristine, Valid points.
The first response I'd make is that there needs to be an element of pragmatism. A patient with an SBP of 91 and MBP of 66 is not necessarily better off than one with an SBP 89 and MAP 64. We need to consider this especiaaly in the elderly hypotensive patient as we can be falsely reassured otherwise- hence the guidelines also including patients with an SBP fall of > 40mmHg. As Tina states, MBP is a better predictor of perfusion than SBP since the circulation (at normal heart rates) spends more time in diastole than in systole: hence its inclusion as a goal in resuscitation. This shouldn't preclude the evaluation of other goals including SBP but also conscious level, cap refill, urine output, etc. Kind regards Ron On Mon, Feb 13, 2012 at 5:25 PM, Kristine Lundeen < [email protected]> wrote: > The Surviving Sepsis Campaign (SSC), defines hypotension as SBP < 90 or > MAP < 65 ( > http://www.survivingsepsis.org/files/Tools/evaluationforseveresepsisscreeningtool.pdf) > when screening a patient for severe sepsis. However, in the sepsis > resuscitation bundle, one of the four standards to measure quality of fluid > resuscitation is whether or not MAP is > 65. Interestingly, they do not > specify that SBP be > 90, only MAP > 65. ( > http://www.survivingsepsis.org/About_the_Campaign/Documents/2008%20Guidelines%20Poster.pdfand > http://www.survivingsepsis.org/Bundles/Individual_Changes/Pages/apply_vasopressors.aspx). > **** > > ** ** > > In the context of SSC sepsis resuscitation, all hypotension (SBP < 90 or > MAP < 65) does not seem to be equal. It appears that SSC uses MAP, not SBP, > as the hemodynamic parameter to consider, when measuring the effectiveness > of fluid and vasopressor resuscitation. **** > > ** ** > > How do providers on this list serve practice? Do you consider the patient > with MAP < 65 as hypotensive, even it her/his SBP is > 90? Is there a risk > of hypoperfusion of end organs, if MAP is still < 65 while SBP > 90? **** > > ** ** > > *Kristine* > > * * > > Kristine Lundeen, RN, MN**** > > MultiCare Health System, Tacoma, WA**** > > Office: 253-403-1164**** > > ** ** > > ** ** > > ------------------------------ > MULTICARE’S SHARED VALUES | Respect | Integrity | Stewardship | Excellence > | Collaboration | Kindness > > Mailgate1.multicare.org <http://mailgate1.multicare.org/> made the > following annotations > --------------------------------------------------------------------- > NOTICE: This e-mail and the attachments hereto, if any, may contain > privileged and/or confidential information. It is intended only for use by > the named addressee(s). If you are not the intended recipient of this > e-mail, you are hereby notified that any examination, distribution or > copying of this e-mail and the attachments hereto, if any, is strictly > prohibited. If you have received this transmission in error, please > immediately notify the sender by email or telephone and permanently delete > this e-mail and the attachments hereto, if any, and destroy any printout > thereof. MultiCare Health System, Tacoma, WA 98415 (253) 403-1000. > ============================================== > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > > -- Dr Ron Daniels Executive Director: Global Sepsis Alliance *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 Survive Sepsis Programme Director First Trustee: U.K Sepsis Trust *Twitter: @sepsisuk*
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