In sever sepsis GDT is predicated on aggressive fluids ,early antibiotics, supporting the respiratory system and vasoactive support as guided by LOC, work of breathing, SaO2, BP, UO, CVP or Wedge and ScVO2, independent of ejection fraction.
It is far easier to treat pulmonary vascular congestion due to over aggressive fluid administration than ARF or ischemic bowel due to under estimating volume requirements. Knowing the EF is an useful adjunct to GDT and a decrease EF will likely increase the changes that with agressive volume resuscitation CVP goal will be reached sooner. A decreased EF may require also earlier use of norepinephrine for BP and dobutamine to meet ScVO2 ,UO, LA and other measures of adequate end organ perfusion. Frank Sebat, MD, FCCP, FCCM Medical Director of Rapid Response System And Clinical Methodologies Kaweah Delta Health Care District Hospital Visalia, CA 559 799 9171 -----Original Message----- From: Mulligan, Ann W. <[email protected]> To: Sepsis list group ([email protected]) <[email protected]> Sent: Sat, Aug 18, 2012 2:15 pm Subject: [Sepsis Groups] Heart failure patients presenting with sepsis Our hospital continues to struggle withmeeting the fluid bolus requirements when a CHF patient with a low EF presentswith sepsis. Cardiology is suggesting that ED perform a bedside ECHO ifthe patient has CHF and/or know reduced ejection fraction, and to be prudentwhen giving several liters of fluid. How are other hospitals approaching thesepatients, and what is the latest guidelines for sepsis treatment within thisdiagnosis? Ann Mulligan, RN, BSN, CPHQ Manager Quality & Outcomes Alta Bates Summit Medical Center 2450 Ashby Ave. Berkeley, CA 94705 Ph: (510)204-2986 Fax: (510)204-1221 Cell: (510)325-4044 [email protected] Confidential Notice: This email is for the sole use of the intendedrecipient and may contain material that is confidential and protected by stateand federal regulations. If you are not the intended recipient pleaseimmediately delete it and contact the sender. Thank you. _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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