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 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 may be collected concurrently — that is, once a patient is placed on the hospital’s severe sepsis protocol, data can be abstracted from the patient chart in real time — or retrospectively using a chart review, a method generally recommended for more experienced improvement teams.