Persistent hypotension is a parameter in the Centers for Medicare and Medicaid Services core measure sepsis (SEP-1) program. The 2016 sepsis definitions use persistent hypotension requiring vasopressors to maintain mean arterial pressure > 65 mm Hg and having a lactate level > 2 mmol/L after fluid resuscitation to define septic shock. In SEP-1, it is defined as 2 blood pressure readings with a systolic blood pressure of 40 mm Hg in the hour after crystalloid fluids have been infused.1,2  Essentially, persistent hypotension is hypotension that does not improve with fluid resuscitation.

The 2017 and 2021 Surviving Sepsis guidelines both suggest the use of dynamic measures such as SV or SVV to assess fluid responsiveness, particularly in complex patients with sepsis. The measurement of SV or SVV in conjunction with a passive leg raise (PLR) or fluid bolus is one method. Fluid responsiveness is determined by an increase...

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