Studies demonstrating the efficacy of Early Goal Directed Therapy have targeted central venous pressures of between 8-12 mm Hg.  For hypotensive patients who have not responded to fluid resuscitation or for those patients with lactate > 4 mmol/L (36 mg/dl), central venous pressure should be maintained 8-12 mm Hg in order to reproduce the mortality reductions cited in the literature.

Note: To remain consistent with the literature, no calculation is provided in the Individual Chart Measurement Tool to account for the effects of positive end-expiratory pressure (PEEP) on central venous pressure.  Clinicians may wish to make note that central venous pressure as an estimate of volume status will be underestimated in patients receiving PEEP.

Compliance with this bundle element is defined as the percent of patients for whom a CVP goal of > 8 mm Hg was achieved within 6 hours following septic shock or lactate > 4 mmol/L (36 mg/dl) identification.

Numerator: The number of patients with severe sepsis with lactate > 4 mmol/L (36 mg/dl) or septic shock for whom a CVP goal > 8 mm Hg was achieved within 6 hours of presentation time

Denominator: The number of patients with severe sepsis with lactate > 4 mmol/L (36 mg/dl) or septic shock

Exclusion: Patients with non-severe sepsis or severe sepsis with lactate < 4 mmol/L (36 mg/dl)

Increase central venous pressure to > 8 mm Hg within 6 hours in 100 percent of indicated cases.

Data is collected for this measure on each individual patient using the Individual Chart Measurement Tool.  This can be done concurrently or retrospectively as detailed here.

Once all the Individual Chart Measurement Tools have been collected for the month, use the Monthly Measurement Worksheet to integrate the data by combining the results of all the Individual Chart Measurement Tools.

At the end of each section on the Monthly Measurement Worksheet you will find a line designated “Numerator” and a line designated “Denominator,” which are ready for input into the pre-configured Improvement Tracker for the measure.

Related Changes

Maintain Adequate Central Venous Pressure