[Sepsis Groups] bundle element 5

[Dave Slessor]

Hi, 

 

I'm just trying to update our emergency department protocol and had a question about bundle 5. In the second part of the bundle it talks about transfusing pts providing that fluid resuscitation has achieved a CVP >8, but in the first part of the bundle it talks about transfusing to achieve the CVP >8. If someone could explain I would be grateful

 

In the event of persistent hypotension despite fluid resuscitation (septic shock) and/or lactate > 4 mmol/L (36 mg/dL) achieve central venous pressure (CVP) of > 8 mm Hg.

 If a patient is both hypovolemic and anemic with a hematocrit less than 30 percent of blood volume, it is appropriate to transfuse packed red blood cells. 


In the event of persistent hypotension despite fluid resuscitation (septic shock) and/or lactate > 4 mmol/L (36 mg/dL) achieve central venous oxygen saturation (ScvO2) of > 70 percent.* 



Techniques to maintain ScvO2 include two principal strategies.  In carrying out early goal directed therapy, if a patient is both hypovolemic and the hematocrit is less than 30%, it is appropriate to transfuse packed red blood cells provided that the fluid resuscitation has achieved a CVP > 8.  If CVP > 8 has not been achieved, additional fluid challenges are needed.   
 
thanks
 
dave
 
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