Do not omit them. They need the fluid if they have hypotension or lactate greater than 4.0. Evidence is now available that fewer will end up on ventilators if they get adequate initial resuscitation, they will have less renal failure and dialysis if they get adequate initial fluid resuscitation. Remember, of 1000 ml of NS only 250 ml stays intravascular. Most septic patients are vasodilated and frequently dehydrated and need fluid. Not giving fluid is dangerous, it increases mortality and is only treating physician fear, not the patient.
Terry P. CLemmer, MD Director of Critical Care Medicine LDS Hospital Salt Lake City, Utah 84143 Professor of Medicine University of Utah School of Medicne Salt Lake City, Utah 84143 Phone: 801-408-3660 Fax: 801-408-1668 [email protected]<mailto:[email protected]> From: [email protected] [mailto:[email protected]] On Behalf Of Tracey Helmick Sent: Tuesday, October 01, 2013 12:41 PM To: [email protected] Cc: [email protected]; [email protected] Subject: [Sepsis Groups] fluid resuscitation in CHF or renal patients Our institution continues to monitor and assess our Sepsis patient data. We are having difficulty meeting the new 30ml/kg recommendations for fluid resuscitation. We are finding that some of our outliers are the patients with CHF or renal failure. Is this a common barrier and if so, what are other institutions doing to assure those patients are receiving adequate fluid resuscitation without causing harm to the patient? Should we omit those patients from our data collection? Respectfully, Tracey Helmick RN, CCRN Meadville Medical Center MMC Severe Sepsis Team Nurse Champion [email protected]<mailto:[email protected]>
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