Professional Documents
Culture Documents
Sepsis Card
Sepsis Card
Severe sepsis affects approximately one million patients and claims more than 250,000 lives
each year in the U.S. It is the second leading cause of death in non-cardiac ICU patients. Early
and aggressive therapy influences outcomes. Utilizing the Surviving Sepsis Campaign Guidelines
improves morbidity and can decrease mortality by 25%.
INFECTION
Defined as a pathologic process caused by the invasion of normally sterile tissue, fluid or body cavity
by pathogenic microorganisms.
SEPSIS
Defined as a suspected or documented infection and two or more of the following variables:
Temperature: > 38.3C (> 101F) or < 36C (< 96.8F)
Heart Rate > 90 bpm
Respiratory Rate > 20 breaths/min
Acutely altered mental status
Hyperglycemia (glucose > 140 mg/dL OR 7.7 mmol/L) in the absence of diabetes
WBC > 12,000/mm3, < 4000/mm3, OR > 10% immature (band) forms
Plasma C-reactive protein more than two SD above the normal value
Plasma procalcitonin more than two SD above the normal value
SEVERE SEPSIS
Defined as sepsis-induced organ dysfunction or tissue hypoperfusion. Organ system dysfunction must
be remote to the site of infection with the exception of pulmonary criteria.
Cardiovascular
Hypotension (SBP < 90 mm Hg, MAP < 70 mm Hg OR an SBP decrease > 40 mm Hg)
Pulmonary
Acute Respiratory Distress Syndrome:
PaO2/FiO2 < 250 in absence of PNA as source
PaO2/FiO2 < 200 with PNA as source
Renal
Acute oliguria (UO < 0.5 mL/kg/hr for 2 hrs despite adequate fluid resuscitation)
Creatinine increase > 0.5 mg/dL from baseline
Hemotologic
Coagulation dysfunction (INR > 1.5 OR PTT > 60 secs absent anticoagulant usage)
Thrombocytopenia (platelet count < 100,000/mm3)
Hepatic/GI
Hyperbilirubinemia (total bilirubin > 2 mg/dL)
Systemic
Hyperlactemia > 2 mmol/L (18.0 mg/dL)
Decreased capillary refill or skin mottling
SSC: survingsepsis.org
References
Bendjelid K, Romand JA: Fluid responsiveness in mechanically ventilated patients: A review of indices used in intensive care.
Intensive Care Med 2003; 29:352360
Gaieski D, McCoy J, Zeserson E, Chase M, Goyal M. Mortality benefit after implementation of early goal directed therapy protocol
for the treatment of severe sepsis and septic shock. Ann Emerg Med. 2005;46:S4.
Jones AE, Shapiro NI, et al.; Emergency Medicine Shock Research Network (EMShockNet) Investigators. Lactate clearance vs
central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010 Feb;303(8)
Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis. Arnold RC, Shapiro
NI, Jones AE, Schorr C, Pope J, Casner E, Parrillo JE, Dellinger RP, Trzeciak S; Emergency Medicine Shock Research Network
(EMShockNet) Investigators. Shock. 2009 Jul;32(1):35-9.
Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Nguyen HB, Rivers EP, Knoblich BP,
Jacobsen G, Muzzin A, Ressler JA, Tomlanovich MC. Crit Care Med. 2004 Aug;32(8):1637-42.
Derived from the Levy MM et all CM 2003 (3)4
2013 This card should be used only as a guideline. In each individual case, the user must ultimately rely on current literature
and the manufacturers product and package insert for additional information on the products recommended use, warnings
and contraindications.
Sepsis Pathway
Lactate 4 mmol/L or persistent hypotension
despite 30 mL/kg crystalloid or colloid equivalent
Broad Spectrum
Antibiotics
< 8 mm Hg
CVP
CVP
8-12 mm Hg
MAP < 65 mm Hg
Vassopressor
MAP
MAP 65 mm Hg
Scv02
< 70%
70%
Goal Achieved
Rivers E, et al. NEJM, 2001;345:1368-1377
Oxygen Delivery
If ScVO2 remains < 70%, oxygen delivery must be further optimized
with pRBC transfusion and/or inotrope therapy:
Transfuse two units pRBCs for Hgb < 7g/dl or consider for Hgb
< 10g/dl if ischemic heart disease or hypoxia.
Initiate inotrope therapy: Dobutamine 2-5 mcg/kg/min