Lippincott Nursing Pocket Card

Recognizing and Managing Sepsis

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Recognizing and Managing Sepsis

Early diagnosis and treatment has been shown to improve patient outcomes and decrease overall mortality from sepsis. Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is a subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality (Singer et al., 2016).

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Sequential (Sepsis-Related) Organ Failure Assessment (SOFA) Score (Vincent et al., 1996)

  • Provides clinical measures to identify organ dysfunction; these criteria can identify infected patients most likely to develop sepsis.
  • Baseline score is assumed to be zero in patients without preexisting organ dysfunction.
  • An increase in score of 2 points or more from baseline represents organ dysfunction.
  • Higher scores are associated with increased probability of mortality.  

Score

0

1

2

3

4

Respiration

PaO2/FiO2 mm HG (kPa)

≥ 400 (53.3)

< 400 (53.3)

 < 300 (40)

< 200 (26.7) with respiratory support

< 100 (13.3) with respiratory support

Coagulation

Platelets, x 103/uL

≥ 150

<150

<100

<50

<20

Liver

Bilirubin, mg/dL (umol/L)

<1.2 (20)

1.2- 1.9 (20 – 32)

2.0- 5.9 (33- 101)

6.0- 11.9 (102 -204)

>12.0 (204)

Cardiovascular

Mean arterial pressure (MAP) and vasopressor therapy (ug/kg/min for at least 1 hour)

MAP ≥ 70 mm Hg

MAP < 70 mm Hg

Dopamine < 5 or dobutamine (any dose)

Dopamine 5.1- 15 OR epinephrine ≤ 0.1 OR norepinephrine ≤ 0.1

Dopamine > 15 OR epinephrine > 0.1 OR norepinephrine > 0.1

Central Nervous System

Glasgow Coma Scale score

15

13-14

10-12

6-9

<6

Renal

Creatinine, mg/dL (umol/L)

<1.2 (110)

1.2- 1.9 (110 – 170)

2.0- 3.4 (171-299)

3.5- 4.9 (300-440)

>5.0 (440)

Urine output, mL/day

 

 

 

<500

<200

Quick SOFA (qSOFA) (Singer et al., 2016)

  • Provides simple bedside criteria to quickly identify adult patients with suspected infection who are likely to have poor outcomes.
  • This screening tool is positive in those with suspected infection and at least 2 of the following criteria:
    • Respiratory rate ≥ 22/min
    • Altered mental status
    • Systolic blood pressure ≤ 100 mmHg  

Sepsis Management: Hour-1 Bundle

Begin the following intervention: (Levy, Evans & Rhodes, 2018):
  • Measure lactate level (repeat lactate if initial lactate elevated (>2mmol/L))
  • Obtain blood cultures before administering antibiotics
  • Administer broad-spectrum antibiotics
  • Begin rapid administration of 30ml/kg crystalloid for hypotension or lactate > 4mmol/L
  • Apply vasopressors if hypotensive during or after fluid resuscitation to maintain mean arterial pressure > 65mm Hg.
*If patient does not present via emergency department, time zero is the earliest documentation in medical record with elements of sepsis or septic shock.

References:
Levy, M.M., Evans, L.E., & Rhodes, A. (2018). The Surviving Sepsis Campaign Bundle: 2018 Update. Critical Care Medicine, 46(6), 997-1000. https://doi.org/10.1097/CCM.0000000000003119

Rhodes, A., Evans, L., Alhazzani, W., Levy, M., Antonelli, M., Ferrer, R., . . . Dellinger, R. (2017). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Critical Care Medicine, 45(3), 486-552. doi: 10.1097/CCM.0000000000002255

Singer, M., Deutschman, C., Seymour, C., Shankar-Hari, M., Annane, D., Bauer, M., . . . Angus, D. (2016). The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Journal of the American Medical Association (JAMA), 315(8), 801-810. doi:10.1001/jama.2016.0287

Society of Critical Care Medicine. (April 2015). Sepsis Campaign Bundles. Retrieved from http://www.survivingsepsis.org/Bundles/Pages/default.aspx

Vincent, J., Moreno, R., Takala, J., Willatts, S., De Mendonca, A., Bruining, H., . . . Thijs, L. (1996). The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Medicine, 22(7), 707-710. doi=10.1007/BF01709751