Location

Virtual Conference

Start Date

12-8-2022 1:25 PM

End Date

12-8-2022 1:45 PM

Description

Stabilizing hemodynamics using intravenous fluid and vasopressor support are essential therapies used to restore tissue perfusion in patients with sepsis. The project site noted poor compliance with the Surviving Sepsis Campaign recommendations for fluid resuscitation and vasopressor support in patients with refractory hypotension. The purpose of this quality improvement project was to determine if or to what degree the implementation of Douglas et al.’s clinical decision algorithm to guide fluid resuscitation impacted the number of patients who required mechanical ventilation when compared to current practice among adult patients with sepsis hypotension and shock in a community hospital in urban California over four weeks. Betty Neuman’s nursing theory and Kurt Lewin’s change theory were the scientific underpinnings of the project. The data was extracted from the facility’s electronic medical record. The total sample size was 42, 13 in the standard care group and 29 in the intervention group. A chi-square test was used to test for differences. The result indicated there was no statistically significant reduction in the number of patients who required mechanical ventilation χ2(1) = 0.90, p = .342. Despite the lack of statistical significance, there was reduced need for mechanical ventilation, n = 5; 38.46% in standard care group and n = 7; 24.14% occurrences in implementation group. Therefore, the implementation of Douglas et al.’s clinical decision algorithm may decrease the need for mechanical ventilation. Recommendation includes continuing the project for further data analysis due to the small sample size.

Keywords: Kurt Lewin’s change theory, Betty Neuman’s nursing theory, sepsis, hypotension, shock, fluid resuscitation, vasopressor support, mechanical ventilation, Douglas et al.’s. clinical decision algorithm.

Event Type

Podium Presentation

Keywords:

california; mission viejo; Kurt Lewin’s change theory, Betty Neuman’s nursing theory, sepsis, hypotension, shock, fluid resuscitation, vasopressor support, mechanical ventilation, Douglas et al.’s. clinical decision algorithm

Comments

References:

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Rice, D. M., Ratliff, P. D., Judd, W. R., Kseibi, S. A., & Eberwein, K. A. (2020). Assessing the impact of CKD on outcomes in septic shock patients receiving standard Vs reduced initial fluid volume. The American Journal of Emergency Medicine, 38(10), 2147-2150. https://doi.org/10.1016/j.ajem.2020.07.055

Roger, C., Zieleskiewicz, L., Demattei, C., Lakhal, K., Piton, G., Louart, B., Constantin, J. M., Chabanne, R., Faure, J. S., Mahjoub, Y., Desmeulles, I., Quintard, H., Lefrant, J. Y., & Muller, L. (2019). Time course of fluid responsiveness in sepsis: The fluid challenge revisiting (FCREV) study. Critical Care, 23, 179 doi: 10.1186/s13054-019-2448-z

Rovas, A., Seidel, L. M., Vink, H., Pohlkotter, T., Pavenstadt, H., Ertmer, C., Hessler, M., & Kumpers, P. (2019). Associations of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis. Critical Care, 23, 260. doi: 10.1186/s13054-019-2542-2

Semler, M. W., Self, W. H., Wanderer, J. P., Ehrenfeld, J. M., Wang, L., Byrne, D. W., Stollings, J. L., Kumar, A. B., Hughes, C. G., Hernandez, A., Guillamondegui, O. D., May, A. K., Weavind, L., Casey, J. D., Siew, E. D., Shaw, A. D., Bernard, G. R., & Rice, T. W. (2018). Balanced crystalloids versus saline in critically ill adults. New England Journal of Medicine, 378(9), 829-839. https://doi.org/10.1056/nejmoa1711584

Shen, Y., Ru, W., H, X., & Zhang, W. (2018). Time-related association between fluid balance and mortality in sepsis patients: Interaction between fluid balance and hemodynamics. Scientific Reports, 8, 10390. doi: 10.1038/s41598-018-28781-4

Taylor, P. S., Karvetski, C. H., Templin, M. A., Heffner, A. C., & Taylor, B. T. (2018). Initial fluid resuscitation following adjusted body weight dosing associated with improved mortality in obese patients with suspected septic shock. Journal of Critical Care, 43, 7-12. doi: 10.1016/j.jcrc.2017.08.025

Tigabu, B. M., Davarai, M., Kebriaeezadeh, A., & Mojtahedzadeh, M. (2018). Fluid volume, fluid balance and patient outcomes in severe sepsis and septic shock: A systematic review. Journal of Critical Care, 48 (2018), 154-159. doi: 10.1016/j.jcrc.2018.08.018

Truong, T. T., Dunn, A. S., McCardle, K., Glasser, A., Huprikar, S., Poor, A., Raucher, B., & Poeran, J. (2019). Adherence to fluid resuscitation guidelines and outcomes in patients with septic shock: Reassessing the “one-size-fits-all” approach. Journal of Critical Care, 51, 94-98. doi: 10.1016/j.jcrc.2019.02.006

Van Mourik, N., Geerts, B. F., Binnekade, J., Veelo, D., Bos, L. D. J., Wiersinga, W. J., van der Poll, T., Cremer, O. L., Schultz, M. J., & Vlaar, A. (2020). A higher fluid balance in the days after septic shock reversal is associated with increased mortality: An observational cohort study, Critical Care Explorations, 2(10). e0219. doi: 10.1097/CCE.0000000000000219

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Aug 12th, 1:25 PM Aug 12th, 1:45 PM

Implementing a Clinical Decision Algorithm to Improve fluid Resuscitation in Sepsis

Virtual Conference

Stabilizing hemodynamics using intravenous fluid and vasopressor support are essential therapies used to restore tissue perfusion in patients with sepsis. The project site noted poor compliance with the Surviving Sepsis Campaign recommendations for fluid resuscitation and vasopressor support in patients with refractory hypotension. The purpose of this quality improvement project was to determine if or to what degree the implementation of Douglas et al.’s clinical decision algorithm to guide fluid resuscitation impacted the number of patients who required mechanical ventilation when compared to current practice among adult patients with sepsis hypotension and shock in a community hospital in urban California over four weeks. Betty Neuman’s nursing theory and Kurt Lewin’s change theory were the scientific underpinnings of the project. The data was extracted from the facility’s electronic medical record. The total sample size was 42, 13 in the standard care group and 29 in the intervention group. A chi-square test was used to test for differences. The result indicated there was no statistically significant reduction in the number of patients who required mechanical ventilation χ2(1) = 0.90, p = .342. Despite the lack of statistical significance, there was reduced need for mechanical ventilation, n = 5; 38.46% in standard care group and n = 7; 24.14% occurrences in implementation group. Therefore, the implementation of Douglas et al.’s clinical decision algorithm may decrease the need for mechanical ventilation. Recommendation includes continuing the project for further data analysis due to the small sample size.

Keywords: Kurt Lewin’s change theory, Betty Neuman’s nursing theory, sepsis, hypotension, shock, fluid resuscitation, vasopressor support, mechanical ventilation, Douglas et al.’s. clinical decision algorithm.