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<EM>Hi, </EM><BR>
<EM></EM> <BR>
<EM>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</EM><BR>
<EM></EM> <BR>
<EM>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.</EM><BR>
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. <BR>
<BR><EM>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.*</EM> <BR>
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<P class=EC_MsoNormal><FONT face=Calibri size=2><SPAN style="FONT-SIZE: 11pt"></SPAN></FONT></P>
<P class=EC_MsoNormal><FONT face=Calibri size=2><SPAN style="FONT-SIZE: 11pt">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. </SPAN></FONT></P>
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<P class=EC_MsoNormal><FONT face=Calibri size=2><SPAN style="FONT-SIZE: 11pt">thanks</SPAN></FONT></P>
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<P class=EC_MsoNormal><FONT face=Calibri size=2><SPAN style="FONT-SIZE: 11pt">dave</SPAN></FONT></P>
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