General clinical management
In the absence of PBFM, physicians used their clinical judgment to prescribe crystalloid fluids to patients who they felt would benefit. Volume, rate, process, and hemodynamic end points of fluid administration varied among physicians. Arterial line placement was usually in the radial position and, alternatively, in the femoral position. Use of a cardiac output monitor to obtain stroke volume (SV), the Flotrac-Vigileo device (software version 1.10; Edwards Lifesciences, Irvine, Calif), was optional (17). While on controlled mechanical ventilation, tidal volumes were kept at 6 mL/kg ideal body weight as far as possible. Nurses administered sedation to achieve a Richmond Agitation Sedation Scale score of -2 to 0 and avoid neuromuscular paralysis. Respiratory therapists awakened and assessed patients for extubation daily. Patients diagnosed as having sepsis had early blood and urine cultures and received empiric antibiotics.