From: Brachial artery reactivity in patients with severe sepsis: an observational study
Code status limitations precluding critical care management (for example, directives against use of mechanical ventilation or vasopressor agents) |
Refusal of patient or designated surrogate decision-maker to provide written informed consent, or inability to obtain consent within 48 hours of diagnosis |
Severe cardiomyopathy with left-ventricular ejection fraction < 30%a |
Chronic dialysis-dependent renal failurea |
History of solid organ or bone marrow/stem cell transplantationa |
Preexisting advanced liver disease (Child-Pugh grade C)a |
Organic nitrate therapya |
Current active bleedinga |
Hematocrit < 22% or < 25% while taking vasopressorsa |
Pregnancy or hormone replacement therapy (HRT)a |
More than 48 hours since severe sepsis/septic shock diagnosis |
Vascular-access device present in the target upper extremityb |
Absent Doppler signals in target upper extremity |
Skin breakdown or soft tissue inflammation involving target upper extremitya |
History of vascular or lymphatic surgery involving target upper extremitya |