• Yana Dilman, Claire Bethel, Navitha Ramesh, and Charlene Myers.
• Yana Dilman is a critical care nurse practitioner in the medical-surgical intensive care unit at University of Pittsburgh Medical Center (UPMC), Mechanicsburg, Pennsylvania, and an adjunct clinical faculty member at Herzing University, Milwaukee, Wisconsin.
• Crit Care Nurse. 2024 Feb 1; 44 (1): 132013-20.

BackgroundFluid responsiveness should be assessed in patients with septic shock because only 50% of patients are fluid responsive. Dynamic measures of fluid responsiveness, like pulse pressure variation measured after a passive leg raise maneuver, are recommended to guide fluid administration in patients with sepsis after initial fluid resuscitation.Local ProblemThe purpose of the project was to evaluate outcomes after implementing a nurse-driven fluid responsiveness evaluation using passive leg raise and pulse pressure variation measurement in patients with septic shock.MethodsThe project included 30 adult patients with septic shock in a 24-bed medical-surgical intensive care unit at a community hospital. A new nursing process was initiated for bedside fluid responsiveness evaluation (pulse pressure variation measurement after passive leg raise). Staff members received in-person individual training sessions. Preintervention and 20-week postintervention patient outcomes data were collected to estimate the project's impact on incidence of fluid overload and acute kidney injury, duration of mechanical ventilation, and intensive care unit length of stay. Preintervention and postintervention staff satisfaction surveys assessed nurses' perception of the project's value.ResultsBefore intervention, 24 of 37 patients (65%) met criteria of fluid overload. The project resulted in a 28% decrease in the incidence of fluid overload. Staff satisfaction surveys revealed a significant increase in nurses' feelings of empowerment to positively affect patient outcomes; all nurses agreed that the new process was efficient.ConclusionThe results indicate that the project had a positive impact on patient outcomes and nurse autonomy.©2024 American Association of Critical-Care Nurses.

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