This is an important question Ann. The research literature has focused on measuring traditional parameters in sepsis resuscitation, despite evidence these parameters suffer from failing to adequately reflect volume status and are often slow to change (CVP being one of the worst offenders). More accurate assessments with ultrasound, both flow and image, are able to give a better idea of adequacy of resuscitation. Measures such as stroke volume response and echo images of EF are likely, in my opinion, to replace most current measures that are used to guide resuscitation. These parameters just need to be better studied in sepsis. Their value in the perioperative and trauma settings, particularly stroke volume optimization, are well supported in research. Tom
Tom Ahrens PhD RN FAAN -----Original Message----- From: George Kramer <[email protected]> To: Mulligan, Ann W. <[email protected]> Cc: Sepsis list group ([email protected]) <[email protected]> Sent: Mon, Aug 20, 2012 8:39 am Subject: Re: [Sepsis Groups] Heart failure patients presenting with sepsis Ann, important question. I am just an observer of sepsis care, but this always seems to be a discussion with uncertain resolution. often leading to delays in therapy. ultrasound assessment of filling and contraction - diastolic and systolic function, would likely help decide when to give fluid to CHF patients as well as those with other co-morbidities or even most septic patients after substantial fluid. When should drugs be administered and when should fluid be continued. etc. Can echo be performed by an attending ICU doc, resident, nurse or does this require a cardiology consult? g George C Kramer, PhD Director, Resuscitation Research Lab Professor, Dept. of Anesthesiology 301 University Blvd. UTMB, Galveston, TX 77555-1102 Office (Mary) 409-747-0077 Direct: 409-772-3969 Cell: 409-939-3040 Lab (Muzna) 409-772-6885 Fax: 409-772-8895 email: [email protected] http://www.utmb.edu/rrl/ On Aug 17, 2012, at 12:13 PM, Mulligan, Ann W. wrote: 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 _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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