The hemodynamic "target": a visual tool of goal-directed therapy for septic patients.
OBJECTIVE
To improve understanding of the hemodynamic status of patients with sepsis by nursing teams through the attainment of hemodynamic parameters using a pentaxial "target" diagram as a clinical tool. Parameters include cardiac index (CI), arterial oxygen saturation (SaO2), mean arterial pressure (MAP), arterial blood lactate, and central venous oxygen saturation (ScvO2).


METHODS



METHODS
Prospective descriptive study.


METHODS
The intensive care unit of a university hospital.


METHODS
During a 6-month period, 38 intubated septic shock patients were included in the study. Survivors and nonsurvivors were compared.


METHODS
MAP, CI, SaO2, ScvO2 and lactate were measured at 0, 6, 12, 24, 36, and 48 h. Measurements were recorded on the target diagram along with the norepinephrine infusion rate and the hemoglobin (Hb) level. The number of lactate and ScvO2 measurements achieved during the target period were compared to a 6-month retrospective control period just before starting the protocol. We assessed the nurse knowledge status prior to the introduction of target diagram. We then performed a post-test after implementing the new recording technique.


RESULTS
The nursing team expressed a positive attitude toward the target concept. The mean number of lactate and ScvO2 measurements performed for each patient during the control period was significantly lower than during the target period, and those values were rarely used as goal values before the introduction of the target diagram. At 24 hours, 46% of the survivors had achieved all the goal parameter values of the target diagram, compared to only 10% of nonsurvivors (P = .01).


CONCLUSIONS
The target diagram is a visual multiparametric tool involving all the medical and nursing team that helps achieve goal-directed therapy for septic patients. The number of goal values reached at each time point during the first 48 hours was closely linked to mortality.
Vallée
Fabrice
F
Anesthesia and Intensive Care Unit Department, Purpan University Hospital, Toulouse, France. vallee.f@chu-toulouse.fr
Fourcade
Olivier
O
Marty
Philippe
P
Sanchez
Pascale
P
Samii
Kamran
K
Genestal
Michèle
M
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002983:Clinical Competence; D002985:Clinical Protocols; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood; D008875:Middle Aged; D009746:Nursing, Team; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D012772:Shock, Septic / Q000097:blood / Q000451:nursing* / Q000628:therapy; D011795:Surveys and Questionnaires; D013997:Time Factors