Hi Christine,
Fluid resuscitation of 3 hour bundle is triggered with signs of hypoperfusion
(lact > or = 4, hypotension).
There are two groups within the severe sepsis population. Severe sepsis without
hypoperfusion = Infection + 2 SIRS plus any 1 organ dysfunction (including
lactate > 2 but < 4, considered an organ dysfunction). The second group is
severe sepsis with hypoperfusion = Infection + 2 SIRS + any 1 organ dysfunction
+ lactate > or = 4, and/or hypoperfusion.
Severe sepsis without hypoperfusion qualifies for BLC, Broad antibiotic,
lactate. Fluid load of 30ml/kg not required. Fluid is clinical decision. Most
clinicians give fluid for elevated lactate, but quality indicator for fluid not
applicable.
Severe sepsis with hypoperfusion qualifies for BLC, Broad antibiotic, lactate,
30 ml/kg fluid load.
For both severe sepsis populations, repeat lactate if initial > 2.0.
Currently with your process, severe sepsis without hypoperfusion patients not
being identified. Elevated creat, INR, Lact > 2 but < 4, Tbili...all meet
criteria for severe sepsis without hypoperfusion. Normal tensive population.
Hope I’ve answered your question.
Patty Cormack
From: Sepsisgroups [mailto:[email protected]] On
Behalf Of Medical
Sent: Saturday, November 22, 2014 8:40 PM
To: [email protected]
Subject: [Sepsis Groups] sepsis diagnosis question
Sent from my iPhone
My name is Dr. Christine Miyake, I have a question about the
diagnosis of severe sepsis. My understanding from the details of all of the
recommendations including the 2012 document that severe sepsis is defined as
sepsis with one or more acute organ dysfunction OR a lactate greater than 4.
But in the guidline below it does not mention organ dysfunction. Because of
this the new hospital I am working for only uses and elevated lactate or
hypotension despite fluids to determine severe sepsis, this seems very wrong to
me. My understanding was you could have severe sepsis with organ dysfunction
and a normal lactate in some cases but they still would require bundle
implementation. Any thoughts, comments, clarification?
Recommendations: Initial Resuscitation and Infection Issues*
A. Initial Resuscitation
1. Protocolized, quantitative resuscitation of patients with
sepsis-induced tissue hypoperfusion (defined in this document as hypotension
persisting after initial fluid challenge or blood lactate concentration
≥ 4 mmol/L). Goals during the first 6 hrs of resuscitation:
a) Central venous pressure 8–12 mm Hg
b) Mean arterial pressure (MAP)
≥ 65 mm Hg c) Urine output ≥ 0.5 mL/kg/hr d) Central venous
(superior vena cava) or mixed venous oxygen saturation 70% or 65%, respectively
(grade 1C).
2. In patients with elevated lactate levels
Christine
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