Implementing a Goal-Directed Therapy Protocol for Fluid Resuscitation in the Cardiovascular Intensive Care Unit

Background: Balancing fluid administration and titration of vasoactive medications is critical to preventing postoperative complications in cardiac surgical patients. Objective: To evaluate the impact of implementing a goal-directed therapy protocol in the cardiovascular intensive care unit on total intravenous fluids administered on the day of surgery, rates of acute kidney injury, and hospital length of stay. Methods: A fluid resuscitation protocol using dynamic assessment of fluid responsiveness with stroke volume index was developed, and nurses were prepared for its implementation using simulation training. Results: After implementation of the new protocol, the total amount of intravenous fluids administered on the day of surgery was significantly reduced (P=.003). There were no significant changes in hospital length of stay (P=.83) or rates of acute kidney injury (P=.86). There were significant increases in nurses' knowledge of (P<.001) and confidence in (P<.001) fluid resuscitation and titration of vasoactive medications after simulation training. Conclusions: Use of a fluid resuscitation protocol resulted in a reduction in the amount of intravenous fluids administered on the day of surgery. The simulation training increased nurses' knowledge of and confidence in fluid resuscitation and titration of vasoactive medications.