Please note the lactate criterion for severe sepsis below – for most of us this is 2.0 +/- [cid:[email protected]]
Lactate > 4.0 is a criterion for the 6 hour bundle Thanks, MARY ANN BARNES-DALY RN BSN CCRN DC | Clinical Performance Improvement Consultant Sutter Health - Clinical Integration Department | 2200 River Plaza Drive, Sacramento, CA 95833 Mobile 916.200.5604| Office 916.286.6717 | [email protected] From: Sepsisgroups [mailto:[email protected]] On Behalf Of Troy Marion Sent: Wednesday, November 26, 2014 8:32 AM To: Medical; [email protected] Subject: Re: [Sepsis Groups] sepsis diagnosis question Dr. Miyake, If the patient meets the SIRS criteria and has an infection, then we screen for severe sepsis. The patient needs to have one of the following: 1. organ dysfunction 2. hypotension 3. lactate greater than 4 You are correct, I have seen many cases with organ dysfunction but a normal lactate. Hope this helps. Troy Troy Marion RN MSN CPHQ Manager Clinical Analytics Performance Improvement Department 215-612-2682 [email protected]<mailto:[email protected]> fax 215-612-4463 >>> Medical <[email protected]<mailto:[email protected]>> >>> 11/22/2014 9:40 PM >>> 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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