3.  Search Engines › CINAHL, PubMED, and Google Scholar  Search Words › Sepsis, Shock, CVP, Fluid Management, Efficacy, Alternatives, etc.  Results › Multiple hits- same author › Not a lot of hits specific to Sepsis

4. Article One Reference: Sasai, T., Tomihiro, F, Mikane, T, Oku, S. Iwsaki, E., Ishii, M.,...Minami, E. (2014). Reliability of central venous pressure to assess left ventricular preload for fluid resuscitation in patients with septic shock. Journal of Intensive Care, 2, 1-7, doi:10.1186/s40560-014-0058-z Article Two Reference: Marik, P.E., & Cavallazzi, R. (2013). Does central venous pressure predict fluid responsiveness? an updated meta-analysis and a plea for some common sense. Journal of Critical Care Medicine, 41, 1774-1781. doi:10.1097/CCM.0b013e31828a25fd

5. Addressed PICO Question P- Severe Sepsis I- Non-Invasive monitoring C- CVP-Invasive monitoring O- Improved Fluid Management

6. CVP monitoring Not reliable measure for fluid resuscitation Non-Invasive Monitoring More accurate measure for fluid resuscitation

7. (Sasaie et al., 2014) Design = Quantitative/Non-Experimental Methods = Descriptive with Retrospective Data Collection Screening of Study Patients

8. Study Design = Summative Methods Meta-Analysis of 43 Studies Subjects Healthy Control patients (n=1) ICU patients (n=22) Operating Room patients (n-20) Results 57% + 13% of all the patients were fluid responders AUC = 0.56 (CI 95%, 0.52-0.60) Correlation co-efficient of baseline CVP and the delta SVI/CI = 0.18 (CI 95%, 0.1-0.25)

9. No subjects manipulated or harmed Subject Anonymity Confidentiality

10. Article #1 by Sasai et al Strength  EBP Pyramid › Level 4 Quality  Good Credibility  Authors  Journal

11. Article #2 by Marik & Cavallazzi Strength  EBP Pyramid › Level 1 Quality  Design/Methods › Correlate with Findings Credibility  Authors  Journal

12. Both Articles Contribute to EBP  Article #1 by Sasai, et al. › Not Generalizable  Article #2 by Marik & Cavallazzi › Generalizable

13. Means for Guiding Fluid Management Needs to be Revised CVP monitoring no longer best practice Other monitoring means should be evaluated

14. Communication Barriers  Physicians  Acute Health Care Staff › Change in Policies/Procedures  Physician Buy In  Revision of Policies and Procedures › Cost › Resources

15. P - Critically Ill Patients I - TEE Monitoring C - CVP Monitoring O - Improved Fluid Resuscitation P - Septic Shock I - Vasopressors C - Fluid Boluses O - Decrease Heart Failure

16.  CVP monitoring is not the best tool to guide fluid resuscitation Key CVP- Central Venous Pressure TTE- Transthoracic Echocardiography LVEDD- Left Ventricular End-Diastolic Diameter LAD- Left Atrial Diameter SVI- Stroke Volume Index CI- Cardiac Index