The nurse is caring for a client newly diagnosed with sepsis. The client has a serum lactate concentration of 6 mmol/L and fluid resuscitation has been initiated. Which value indicates that the client has received adequate fluid resuscitation?

A) ScvO2 of 60%
B) Urine output of 0.2 mL/kg/hr
C) Mean arterial pressure of 70 mm Hg
D) Central venous pressure of 6 mm Hg

During the treatment of sepsis, a patient will be given copious amounts of fluids, specifically those like Lactated Ringer's, because lactate can be converted to bicarbonate which aids in the reversal of an acidotic state while the fluid itself can help restore intravascular volume that may have diminished when the body's normal fluid volume shifted to entering the interstitial space, causing edema.

An indication that the treatment is working is an increase in the patient's mean arterial pressure (MAP), option C. An increase in MAP tells the providers that the patient's tissues are adequately perfusing oxygen and nutrients and the blood pressure remains regulated. The value of map is expected to be above 65 mmHg because this is the minimum pressure necessary to perfuse peripheral tissues and vital organs.

Why Not Other Choices:

Central venous oxygen saturation (ScvO2) measures how well oxygen is returning to the heart following perfusion, a great measurement for the effectiveness of fluid resuscitation. However, the goal in patients with sepsis is >70%.

Urine output (UO) -- the amount of urine a patient is producing and eliminating -- returning to normal can also mean the patient is responding well to fluid resuscitation. However, the ideal urine output is between 0.5 to 1 mL/kg/hr. UO below this range may indicate worsening sepsis.

Central venous pressure (CVP) should be monitored if possible during sepsis, but current evidence does not reflect a correlation as a predicator of fluid resuscitation efficacy. Atop this, CVP is expected to be in the range of 8 to 12 mmHg.