The following is a summary of “A service evaluation of measuring fluid responsiveness in acutely unwell hypotensive patients outside of critical care,” published in the April 2024 issue of Critical Care by Rossiter et al.
Timely identification and effective management are not just important, they are crucial for reducing sepsis-related mortality. The Surviving Sepsis Campaign’s recommendation for dynamic measurements to guide fluid resuscitation is a clear call to action, and it’s time we start using these techniques more frequently to monitor cardiac output.
Researchers conducted a retrospective study assessing the safety and effectiveness of a nurse-driven protocol integrating non-invasive cardiac output monitoring for goal-directed fluid management in patients with hypotension.
They implemented a goal-directed fluid management protocol into critical care outreach teams’ standard clinical assessment routine. The study evaluated two groups of patients: a pre-intervention group of 49 sequential controls and a post-intervention group of 39 sequential controls.
The result showed that the post-intervention received significantly less fluid (750 ml) in the 6 hours following assessment than the pre-intervention group (1200 ml). Despite similar baseline characteristics and rates of renal replacement therapy, the post-intervention group experienced a notable reduction in the need for invasive and non-invasive ventilation (0% vs. 31%). Although the groups were comparable, the patients in the post-intervention cohort exhibited lower recorded blood pressures.
Investigators concluded that non-invasive fluid monitoring empowered nurses to optimize fluid resuscitation in septic shock, and timely use of appropriate vasopressors can lead to better patient outcomes.
Source: sciencedirect.com/science/article/abs/pii/S0964339724000764
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