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Instite Of Medicine Impact , Sepsis

3955 words - 16 pages

A review of the
latest guidelines
By Julie Miller, BSN, RN, CCRN


AFFECTING MILLIONS OF people worldwide, sepsis
is a systemic response to an overwhelming inflammatory
process caused by an infection. Approximately one in four
people who develop sepsis will die.1 In January 2013, the
international Surviving Sepsis Campaign Guidelines
Committee published its 2012 surviving sepsis guidelines
(SSG), an update to the 2008 guidelines for early identification and management of sepsis in adults.1 The
guidelines highlight the importance of screening every
potentially infected patient for sepsis and providing
best-practice interventions for managing ...view middle of the document...

1 Recognizing that a patient
has sepsis before it progresses to
severe sepsis is essential for early
intervention to prevent further
progression to septic shock.

Septic shock is sepsis-induced
hypotension that persists despite
adequate fluid resuscitation. Sepsisinduced hypotension is defined as
systolic BP (SBP) less than 90 mm
Hg, MAP less than 70 mm Hg, or a
decrease in SBP greater than 40 mm
Hg or less than two standard
deviations below normal for age
in the absence of other causes of

Screening patients for sepsis includes monitoring for signs and
symptoms of infection and identifying subtle changes in vital signs,
mental status, urine output, lab values, and/or markers of tissue perfusion. (See Screening patients for sepsis, severe sepsis, or septic shock.)
Identifying sepsis quickly allows for
early goal-directed therapy, potentially reducing the patient’s mortality

Screening patients for sepsis, severe sepsis, or septic shock1

Severe sepsis

Septic shock

Suspected or documented infection plus
some of the following:

Criteria from previous column plus
any of the following thought to be
due to the infection:

All of the criteria from
previous columns

• sepsis-induced hypotension

• SBP 140 mg/dL in the absence
of diabetes)
Inflammatory variables
• white blood cell (WBC) count >12,000/mm3 or 10% immature forms (bands)

• acute lung injury with PaO2/FiO2
2.0 mg/dL
• bilirubin >2 mg/dL
• platelet count 40
mm Hg or less than
two standard
deviations below
normal for age
in the absence of
other causes of

• plasma C-reactive protein more than two standard
deviations above the normal value
• plasma procalcitonin more than two standard deviations
above the normal value
Hemodynamic variables
• SBP 60 seconds)
• ileus (absent bowel sounds)
• thrombocytopenia (platelet count 4 mg/dL)
Tissue perfusion variables
• serum lactate >1 mmol/L
• decreased capillary refill or mottling

26 l Nursing2014 l April

Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Targeted time frames and goals of initial therapy1
Within 1 hour of recognition of severe sepsis or septic
shock initiate the following and complete within 3 hours:

Within 6 hours of recognition of severe sepsis or
septic shock:

• Obtain blood culture specimens before antibiotic administration.

• Infuse vasopressors (for hypotension that doesn’t respond
to initial fluid resuscitation or for abnormally low diastolic
BP) to maintain MAP of 65 mm Hg or greater; I.V. norepinephrine is first choice.

• Obtain serum lactate level.
• Administer broad-spectrum antibiotic (don’t delay more than
45 min for blood cultures).
• Initiate 30 mL/kg isotonic crystalloid fluids for hypotension or
lactate level of 4 mmol/L or greater (may use albumin as part
of initial fluid resuscitation in patients...

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