Challenges in Sepsis Care: New Sepsis Definitions and Fluid Resuscitation Beyond the Central Venous Pressure

Maureen A Seckel; Thomas Ahrens

doi:10.1016/j.cnc.2016.08.001

Challenges in Sepsis Care: New Sepsis Definitions and Fluid Resuscitation Beyond the Central Venous Pressure

Crit Care Nurs Clin North Am. 2016 Dec;28(4):513-532. doi: 10.1016/j.cnc.2016.08.001. Epub 2016 Sep 26.

Authors

Maureen A Seckel¹, Thomas Ahrens²

Affiliations

¹ Christiana Care Health Services, Affiliated Faculty, College of Nursing, University of Delaware, 4755 Ogletown-Stanton Road, Newark, DE 19711, USA. Electronic address: Mseckel@christianacare.org.
² Barnes-Jewish Hospital, St Louis, MO 63110, USA.

PMID: 28236396
DOI: 10.1016/j.cnc.2016.08.001

Abstract

There are two important recent changes in sepsis care. The first key change is the 2016 Sepsis-3 definitions from the recent consensus workgroup with new sepsis and septic shock definitions. Useful tools for assessing patients that have a greater risk of mortality include Sequential Organ Failure Assessment (SOFA) in intensive care units and quick SOFA outside intensive care units. The second change involves management of fluid resuscitation and measures of volume responsiveness. Measures such as blood pressure and central venous pressure are not reliable. Fluid challenges and responsiveness should be based on stroke volume change of greater than 10%.

Keywords: Fluid challenge; Fluid responsiveness; Sepsis; Stroke volume.

Publication types

Review

MeSH terms

Central Venous Pressure
Consensus Development Conferences as Topic*
Fluid Therapy / nursing
Fluid Therapy / standards*
Humans
Intensive Care Units
Organ Dysfunction Scores*
Shock, Septic / diagnosis*
Shock, Septic / mortality
Shock, Septic / therapy*
Stroke Volume*