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Implementing a Goal-Directed Therapy Protocol for Fluid Resuscitation in the Cardiovascular Intensive Care Unit
Lori Dugan Brien1, Marilyn H Oermann2, Margory Molloy3
1Lori Dugan Brien is Acute Care Nurse Practitioner, Cardiovascular and Thoracic Surgery Department, Virginia Hospital Center, 2425 N Woodrow St, Arlington, VA 22207 (Duganl@georgetown.edu).
Background:
Balancing fluid administration and titration of vasoactive medications is critical to preventing postoperative complications in cardiac surgical patients.
Objective:
To evaluate the impact of implementing a goal-directed therapy protocol in the cardiovascular intensive care unit on total intravenous fluids administered on the day of surgery, rates of acute kidney injury, and hospital length of stay.
Methods:
A fluid resuscitation protocol using dynamic assessment of fluid responsiveness with stroke volume index was developed, and nurses were prepared for its implementation using simulation training.
Results:
After implementation of the new protocol, the total amount of intravenous fluids administered on the day of surgery was significantly reduced (P = .003). There were no significant changes in hospital length of stay (P = .83) or rates of acute kidney injury (P = .86). There were significant increases in nurses' knowledge of (P < .001) and confidence in (P < .001) fluid resuscitation and titration of vasoactive medications after simulation training.
Conclusions:
Use of a fluid resuscitation protocol resulted in a reduction in the amount of intravenous fluids administered on the day of surgery. The simulation training increased nurses' knowledge of and confidence in fluid resuscitation and titration of vasoactive medications.
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