The decision to measure the application of vasopressors is unfortunate in my view.
However, since it is measured, it is important to recall that the any time a vasopressor is applied, the goal is to wean it, not maintain it. Thus while the measure checks to see that vasopressors were applied (ostensibly to prevent imminent cardiovascular collapse) they can be immediately weaned to off as long as MAP > 65, perhaps with additional fluids. On Nov 2, 2015, at 9:52 AM, Myran, Robin <[email protected]<mailto:[email protected]>> wrote: All – I submitted this question through QualityNet, but was interested in your thoughts… The sepsis protocol at our hospital includes the administration of 30 cc/kg crystalloid for hypotension or lactate >=4. If the patient remains hypotensive after the initial bolus, we have the option of administering an additional 30 cc/kg. Often this second bolus works to achieve a sustained MAP >=65. According to the specifications manual for SEP-1, we *must* start a vasopressor by the 6th hour if the patient remains hypotensive in the hour after the initial bolus is complete, correct? The Surviving Sepsis Campaign's recommendations include "a minimum of 30 mL/kg of crystalloids" and that "greater amounts of fluid may be needed in some patients." They go on to say that "fluid administration is continued as long as there is hemodynamic improvement". My physicians will always go to more fluids first (if the patient remains fluid responsive) before starting vasopressors. Can you provide additional information/clarification so I can educate my clinicians? Robin Myran, MSN, RN, PCCN Sepsis Coordinator Hoag Memorial Hospital Presbyterian One Hoag Drive Newport Beach, CA 92658 Office: (949) 764-4588 Fax: (949) 764-5387 Cell: (949) 300-9137 [email protected]<mailto:[email protected]> Please note that the information contained in this message and any files transmitted with it are privileged and confidential and are protected from disclosure under the law, including the Health Insurance Portability and Accountability Act (HIPAA). If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited and may subject you to criminal or civil penalties. If you have received this communication in error, please notify the sender by replying to the message and delete the material from any computer. Thank you, Hoag Memorial Hospital Presbyterian and its Affiliates _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[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
