Scribd Logo
Upload

Welcome to Scribd!

  • 17 views

    6 PDF

    Uploaded by

    ellya theresia

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    6 PDF

    Uploaded by

    ellya theresia
    17 views2 pages

    Original Title

    6.pdf

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    17 views2 pages

    6 PDF

    Uploaded by

    ellya theresia

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Fluids for Sepsis

    Guidance from the Surviving Sepsis Campaign 2016

    • The recommendation, for the initial fluid resuscitation from sepsis-induced hypoperfusion, is to infuse at least
    30 mL/kg of intravenous crystalloid fluid within the first three hours.
    • Fluids should be administered for hypotension, lactate ≥ 4 mmol/L or septic shock.
    • The recommendation is to provide initial fluid resuscitation rapidly; do not infuse using an IV pump.
    o For example, give 1-liter IV fluid over 15 minutes using a pressure bag.
    • More rapid administration and greater amounts of fluid may be needed in patients with sepsis-induced tissue
    hypoperfusion.
    • Administration of 30 mL/kg crystalloid fluids is recommended in patients with end-stage renal disease on dialysis or
    chronic heart failure with frequent assessment of patient’s oxygenation status.
    • Additional fluids should be guided by frequent reassessment of hemodynamic status. See also Optimizing Fluid
    Management in Sepsis Patients.
    • Recommended measurements include MAP, BP, HR, urine output, capillary refill, cardiac ultrasound, ScvO2, lactate
    clearance.
    • Dynamic pressure measurements such as pulse pressure variation and stroke volume variation are recommended to
    evaluate fluid responsiveness in patients with sepsis.
    • Traditional hemodynamic measurements such as CVP or PAOP are no longer recommended due to their static nature
    (measure only a point in time) and their inability to predict fluid responsiveness.
    • Recommended resuscitation end-points are:
    o MAP > 65 mmHg
    o Normalization of the lactate
    o Dynamic measurement indicates patient is no longer fluid responsive

    Key articles:

    • Early Liberal Fluid Therapy for Sepsis Patients is Not Harmful: Hydrophobia Is Unwarranted but Drink
    Responsibly. (2016). Critical Care Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5113226/
    • Fluid Resuscitation and Clinical Outcomes in Patients with Known Heart Failure Who Develop Severe Sepsis or
    Septic Shock. (2016). CHEST. https://doi.org/10.1016/j.chest.2016.08.363
    • Increased Fluid Administration in the First Three Hours of Sepsis Resuscitation Is Associated With
    Reduced Mortality: A Retrospective Cohort Study. (2014). CHEST. https://doi.org/10.1378/chest/13-2702
    • Volume of Fluids Administered During Resuscitation for Severe Sepsis and Septic Shock and the Development
    of the Acute Respiratory Distress Syndrome. (2014). Journal of Critical Care.
    http://dx.doi.org/10.1016/j.jcrc.2014.06.005

    ©2019 CHA
    The diagram below explores the nuancing of initial administration of 30 mL/kg crystalloid for sepsis-induced hypoperfusion
    based on patient characteristics. It also draws attention to reassessment tools following the initial dose as an influence on
    further fluid administration or inotropic therapy (Dellinger, 2017, open access).

    References
    • Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., . . . Dellinger, R. P. (2017). Surviving Sepsis Campaign:
    International Guidelines for Management of Sepsis and Septic Shock: 2016. Critical Care Medicine, 45(3), 486-552.
    https://doi.org/10.1097/CCM.0000000000002255
    • Dellinger, R. P., Schorr, C. A., & Levy, M. M. (2017). A User’s Guide to the 2016 Surviving Sepsis Guidelines. Critical Care Medicine,
    45(3), 381-385. https://doi.org/10.1097/CCM/0000000000002257

    ©2019 CHA

    ©2019 CHA

    You might also like