A service evaluation of measuring fluid responsiveness in acutely unwell hypotensive patients outside of critical care.

Autor: Rossiter A; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK. Electronic address: adamrossiter@doctors.org.uk., Hilton JA; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Berlin, Germany., Fizza Haider S; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK; Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK., Nasser SMT; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK; Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK., Boyer N; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK., Cooper C; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK., Davis C; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK., Marshall D; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK., Skelding E; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK., Pike J; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK., Jarratt L; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK., Wood L; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK., Knight L; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK., Holmes S; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK., Cowman T; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK., Shepley E; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK., Dubravac N; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK., Gray W; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK., Munday C; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK., Creagh-Brown B; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK; Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK., Forni L; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK; Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
Jazyk: angličtina
Zdroj: Intensive & critical care nursing [Intensive Crit Care Nurs] 2024 Oct; Vol. 84, pp. 103694. Date of Electronic Publication: 2024 Apr 22.
DOI: 10.1016/j.iccn.2024.103694
Abstrakt: Introduction: Early recognition and prompt, appropriate management may reduce mortality in patients with sepsis. The Surviving Sepsis Campaign's guidelines suggest the use of dynamic measurements to guide fluid resuscitation in sepsis; although these methods are rarely employed to monitor cardiac output in response to fluid administration outside intensive care units. This service evaluation investigated the introduction of a nurse led protocolised goal-directed fluid management using a non-invasive cardiac output monitor to the standard assessment of hypotensive ward patients.
Methods: We introduced the use of a goal-directed fluid management protocol into our critical care outreach teams' standard clinical assessment. Forty-nine sequential patients before and thirty-nine after its introduction were included in the assessment.
Results: Patients in the post-intervention cohort received less fluid in the 6 h following outreach assessment (750mls vs 1200mls). There were no differences in clinical background or rates of renal replacement therapy, but rates of invasive and non-invasive ventilation were reduced (0% vs 31%). Although the groups were similar, the post-intervention patients had lower recorded blood pressures.
Conclusion: IV fluid therapy in the patient with hypotension complicating sepsis can be challenging. Excessive IV fluid administration is commonplace and associated with harm, and the use of advanced non-invasive haemodynamic monitoring by trained nurses can provide objective evaluation of individualised response to treatment. Avoiding excessive IV fluid and earlier institution of appropriate vasopressor therapy may improve patient outcomes.
Implications for Clinical Practice: Adoption of dynamic measures of cardiac output outside of critical care by trained critical care nurses is feasible and may translate into improved patient outcomes. In hospitals with a nurse-led critical care outreach service, consideration should be given to such an approach.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024. Published by Elsevier Ltd.)
Databáze: MEDLINE
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