We are still using ScvO2 but the recent study suggests and controversy is using Lactate clearance as an indicator. See: Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010;303(8):739.
Eric _____________________________ Eric Ramos MD, FAAFP, CMO Far West Division, HCA o) 702-938-9653 c) 702-305-6767 f) 877-836-8498 -----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of Mary Draper Sent: Friday, March 16, 2012 12:35 PM To: 'Thomas Morris'; Andy Bourgeois; Johnston, Roberta Cc: [email protected] Subject: Re: [Sepsis Groups] SIRS temperature criteria We have stopped inserting this catheter. We found it was more work for staff in the ED to calibrate. Our intensivists will order a mixed venous to measure ScVo2. Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 [email protected] -----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of Thomas Morris Sent: Tuesday, March 13, 2012 1:01 PM To: Andy Bourgeois; Johnston, Roberta Cc: [email protected] Subject: Re: [Sepsis Groups] SIRS temperature criteria Greetings All Is the Rivers paper from 2001 something that we still stick by? I just had a look at the methods section and it seems the only thing different from "standard care (which involved CVP, MAP and UO monitoring) was measurement of central venous O2 sats. Is SVO2 still something that's routinely looked after? I had a feeling this paper had been "superceded" in some way. Thanks very much indeed Tom Morris (ID/Micro Registrar, John Radcliffe Hospital, Oxford) On Mon, 27 Feb 2012 09:48:16 -0800 Andy Bourgeois <[email protected]> wrote: > SIRS criteria have been defined differently in various studies. > > The temperature was 38 degrees C in a few early >articles: > > *One of the early definitions of sepsis:* Definitions for sepsis and >organ failure and guidelines for the use of innovative therapies in >sepsis. The ACCP/SCCM Consensus Conference Committee. American College >of Chest Physicians/Society of Critical Care Medicine. > Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein >RM, Sibbald WJ. > Chest. 1992 Jun;101(6):1644-55. Review > > *The original Early Goal Directed Therapy article from >2001* > Early goal-directed therapy in the treatment of severe sepsis and >septic shock. > Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, >Peterson E, Tomlanovich M; Early Goal-Directed Therapy Collaborative >Group. > N Engl J Med. 2001 Nov 8;345(19):1368-77. > > Most of the more recent studies and reviews use 38.3 degrees C: > > *International Sepsis Definitions Conference in 2001* > 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions >Conference. > Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, >Opal SM, Vincent JL, Ramsay G; SCCM/ESICM/ACCP/ATS/SIS. > Crit Care Med. 2003 Apr;31(4):1250-6. Review. > > *In this 2006 review article from some of the original Early Goal >Directed Therapy investigators:* Severe sepsis and septic shock: >review of the literature and emergency department management >guidelines. > Nguyen HB, Rivers EP, Abrahamian FM, et al. > Ann Emerg Med. 2006 Jul;48(1):28-54. Epub 2006 May 2. >Review. > > *The Surviving Sepsis Campaign - 2008* Surviving Sepsis Campaign: >international guidelines for management of severe sepsis and septic >shock: 2008. > Dellinger RP, Levy MM, Carlet JM, et al. > Crit Care Med. 2008 Jan;36(1):296-327. Erratum in: Crit Care Med. 2008 >Apr;36(4):1394-6. > > I'd recommend 38.3 degrees C to match the more recent definitions so >that your sepsis statistics can be easily compared to published >studies. > > Here's an article on comparison of methods of measuring temperature. > Bottom line is that IR ear probes are somewhat variable and axillary >reads too low. Go with oral, rectal or bladder. > > Erickson RS, Kirklin SK. Comparison of ear-based, bladder, oral, and >axillary methods for core temperature measurement. Crit Care Med. >1993 > Oct;21(10):1528-34. > PubMed PMID: 8403963. > > > Andy Bourgeois, MD, FAAEM, FACEP > Emergency Medicine > Simi Valley Hospital > > > > > On Thu, Feb 23, 2012 at 11:47 AM, Johnston, Roberta < > [email protected]> wrote: > >> Hi everyone- Our Sepsis committee would like to know if >>the temp >> criteria is 38.3 or 38, and is the method of obtaining >>the temperature? >> Thanks in advance, Roberta**** >> >> ** ** >> >> Roberta Johnston, RN,BS,CMC. >> Cardiopulmonary Case Manager >> 700 High St. >> Williamsport, Pa. 17701 >> Phone:570-321-2112, Fax:570-321-2822;Cell: 570-560-8993 >> [email protected]**** >> >> >> **** >> >> Confidentiality Notice: This message and any attachments >>originate by >> electronic mail from Susquehanna Health System and their >> subsidiaries/affiliates ("SHS"). 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