Urine output (UO) goals to be assessed daily from randomization to 96 hours |
UO > 5 L/d → Reduce current diuretic regimen if desired
|
UO 3–5 L/d → Continue current diuretic regimen |
UO < 3 L/d → See diuretic grid |
24-hour assessment |
UO recommendations as above |
Advance to next step on grid if UO < 3 L/d |
48-hour assessment |
UO recommendations as above |
Advance to next step on grid if UO < 3 L/d |
Consider dopamine or dobutamine at 2 μg/kg/h if SBP < 110 mm Hg and EF <40% or RV systolic dysfunction. |
Consider nitroglycerin or nesiritide if SBP > 120 mm Hg (any EF) and severe symptoms |
72- and 96-hour assessments |
UO recommendations as above |
Advance to next step on grid if UO < 3 L/d |
Consider dopamine or dobutamine at 2 μg/kg/hr if SBP < 110 mm Hg and EF <40% or RV systolic dysfunction. |
Consider nitroglycerin or nesiritide if SBP > 120 mm Hg (any EF) and severe symptoms |
Consider hemodynamic guided IV therapy, LVAD, dialysis, or ultrafiltration crossover |