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2021 prov rn ca; 2021 prov rn poster; california; plcmmc
Background & Significance: The leading cause of death of critically ill patients is sepsis. The CDC reports that sepsis is estimated to be responsible for 1 of every 3-hospital deaths. Furthermore, in hospitals located in California for one large hospital system, a reported30.74% patients admitted to the ICU with sepsis died in the year 2017.
Purpose: The purpose of the study was to determine if utilizing non-invasive pulse contour technology (PCT) is a feasible intervention to manage fluid responsiveness and resuscitation specifically with septic patients in a community Intensive Care Unit in California. A secondary aim was to determine if use of PCT and a nurse-driven algorithm for fluid resuscitation could improve patient outcomes with respect to mortality rate, ICU length of stay in days, and ICU ventilator use days.
Methods: A single-cohort feasibility study with 50 participants was conducted. Subjects were admitted to ICU directly from the Emergency Department with primary diagnosis of sepsis/septic shock, and enrolled within 24 hours of admission. Subjects had the Pulse Contour Technology applied, remaining in place for 72 hours or until discharge from ICU. A nurse driven algorithm was utilized to determine when the patient was to be given IV fluids verses starting vasopressors based on fluid responsiveness. Retrospective and prospective data was collected using specific inclusion and exclusion criteria. A certified statistician consulting with our hospital analyzed all data using standard SPSS software.
Results: Out of the 50 patients enrolled in the prospective study the algorithm was applied 92.3% of the time. This indicates that a nursing driven protocol for fluid management is feasible in the community hospital ICU setting. We found that the PCT did guide fluid resuscitation. When comparing the prospective data to the retrospective data we found that mortality decreased from 31% to 22%, ventilation days decreased from 5.3 to 1.3, and length of stay decreased from 6.4 to 3.2 days. Finally, we assessed the prospective data, finding that 62% of patients were considered fluid overloaded per definition. There was no statistical significance between fluid overload and procedures performed.
Conclusion: Utilizing PCT and algorithm to guide fluid management in sepsis patients to determine if a patient needs vasopressors verses fluids demonstrated positive outcomes. Going further it can assist in bed selection from ER, or RRT; identifying if septic patient requires ICU for vasopressor therapy or step down unit for further fluid resuscitation. It would be beneficial to conduct a larger scale study to determine if the results translate beyond our community hospital setting.
Conference / Event Name
2021 Providence RN Conference
Kitago, Natalie; Tuong, Lak; and Rosenberg, Sarah, "How Much is too Much: Examining Fluid Responsiveness in Septic Patients" (2021). View all. 29.