I like Greg's answer!
On Apr 24, 2015, at 7:07 AM, Martin, Greg <[email protected]<mailto:[email protected]>> wrote: There are two recent studies that have examined the timing of vasopressor administration in septic shock. One from Anand Kumar, known for demonstrating the impact of delayed antibiotics on septic shock mortality, and the other from a group in China. Both studies conclude that earlier administration is associated with better outcomes (survival). The exact timing of administration is difficult – we all agree it is difficult to not administer vasopressors to a hypotensive patient when their blood pressure does not improve quickly for initial aggressive fluid administration. http://ccforum.com/content/18/3/R97/abstract http://ccforum.com/content/18/5/532/abstract Greg ____________________________________ Greg S. Martin, M.D., M.Sc. Professor and Associate Division Director for Critical Care Division of Pulmonary, Allergy and Critical Care Emory University School of Medicine Director, Clinical Research Network Atlanta Clinical and Translational Science Institute<http://www.actsi.org/> Director of Research, Emory Center for Critical Care<http://emoryhealthcare.org/Critical-Care> Associate Director, Emory/Georgia Tech Predictive Health Institute<http://predictivehealth.emory.edu/> Director, Center for Health Discovery and Well Being<http://predictivehealth.emory.edu/chd/index.html> Section Chief, Pulmonary, Allergy, Critical Care and Sleep<http://medicine.emory.edu/pulmonary-allergy-critical-care/> Grady Memorial Hospital Administrative Coordinator: Paula Massey, (404) 616-0148 [email protected]<mailto:[email protected]> <image001.jpg> Ask me about Critical Care Summit 2016 in Atlanta<http://www.criticalcaresummit.com/> <image002.jpg>Go Green: Please do not print this e-mail unless absolutely necessary. -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Townsend, Sean, M.D. Sent: Thursday, April 23, 2015 11:26 AM To: Jeanie Bollinger Cc: [email protected]<mailto:[email protected]> Subject: Re: [Sepsis Groups] SCCM guidelines: vasopressors Since both groups in ARISE did receive vasopressors, although usual care received marginally fewer applications, I don't think you can conclude they make no difference. You would have to assert that the small number who received fewer applications somehow had statistical significance and I'm sure that number is far too small. Plus that's a secondary analysis of a test not intended by the trial -- long and short, don't draw this false conclusion. That said nobody really knows if vasopressors save lives in sepsis. Truth is really very simple -- most docs cannot stand to look at a BP of 70/40 and sit on it after a good fluid bolus fails. If you've got docs that feel comfortable doing that, I'd say they are daredevils unlike the average ED doc or intensivist! On Apr 23, 2015, at 7:17 AM, Jeanie Bollinger <[email protected]<mailto:[email protected]<mailto:[email protected]%3cmailto:[email protected]>>> wrote: Hello group, I have a question on the CMS bundle and the revised SCCM guidelines concerning volume resuscitation and application of vasopressors. The 3 hours bundle states fluid 30ml/kg for hypotension or lactate >4. The 6 hour bundle states to apply vasopressors for hypotension that does not respond to initial fluid resuscitation. Is the recommendation to add vasopressor after 30ml/kg or can the provider give more fluid and then within the 3-6 hour window then apply vasopressors for sustained hypotension? There is discussion among our team referring to the ARISE trial and that the variable of vasopressor therapy did not change outcomes. Any insight on the perspective of others is appreciated. Jeanie Bollinger Jeanie Bollinger MSN,RN,ACCNS-AG, CCRN Sepsis Clinical Nurse Specialist Nursing Department of Excellence Mission Health Asheville, NC Phone: 828-213-7171 Beeper: 828-207-2363 ________________________________ ________________________________ This message and its attachments may contain confidential and/or legally-sensitive information that is intended for the sole use of the addressee(s). 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