Early Identification and Treatment of Sepsis
Early Identification and Treatment of Sepsis
Early Identification and Treatment of Sepsis
Review
Infection
Keywords: Sepsis/Screening/Infection
This
Alamy
What is sepsis?
5 key
points
Sepsis is one
of the leading
causes of death in
hospital patients
worldwide
Patients with
severe sepsis
will not respond to
fluid replacement
Sepsis can be
identified
during routine
observations so
nurses play a vital
role in spotting
symptoms
All patients
with sepsis
should have a
management
plan that includes
level of
observation, review
schedule and an
escalation plan
Clear
guidance on
identification and
evidence-based
interventions is
available to
support effective
and safe care
2
3
Nursing
Times.net
Box 1. definitions
Systemic inflammatory response
syndrome (SIRS) The systemic
inflammatory response to a variety of
severe clinical insults. The response is
manifested by two or more of the
following conditions:
Temperature >38C or <36C
Heart rate >90bpm
R
espiratory rate >20 breaths/min or
PaC02 <32mmHg
W
hite blood cell count >12,000/mm3
<4,000/mm3, or >10% immature
(band) forms
Sepsis The systemic response to
infection, manifested by two or more of
the following, as a result of infection:
Temperature >38C or <36C
Heart rate >90bpm
R
espiratory rate >20 breaths/min or
PaC02 <32mmHg and white blood
cell count >12,000cells/mm3
<4,000cells/mm3 or >10% immature
(band) forms
Severe sepsis is associated with
organ dysfunction, hypoperfusion or
hypotension. Hypoperfusion and
perfusion abnormalities may include
but are not limited to lactic acidosis,
oliguria or an acute alteration in mental
status
Septic shock Sepsis-induced with
hypotension despite adequate fluid
resuscitation, along with the presence
of perfusion abnormalities that may
include but are not limited to lactic
acidosis, oliguria or an acute alteration
in mental status. Patients receiving
inotropic or vasopressor agents may
not be hypotensive at the time that
perfusion abnormalities are measured
Sepsis-induced hypotension A
systolic blood pressure <90mmHg or a
reduction of 2:40mmHg from baseline
in the absence of other causes for
hypotension
Multiple organ dysfunction
syndrome (MODS) The presence of
altered organ function in an acutely ill
patient such that homoeostasis cannot
be maintained without intervention
Bacteria
Other
Infection
Fungi
Sepsis
SIRS
Trauma
Parasites
Viruses
Other
Burns
Pancreatitis
Blood-borne infection
Identification of sepsis
Box 2. Systemic
inflammatory
response syndrome
Temperature >38.3C or <36.0C
Heart rate >90bpm
Respiratory rate >20 breaths/min
White cell count <4 or >12g/L
New altered mental state
Blood glucose >7.7mmol/L (not
diabetic)
Nursing Practice
Review
fig 2. CHFT sepsis screening tool
Sepsis confirmed by >2 clinical signs and indication of infective source
Yes
If yes, consider the following question
Yes
If the previous considerations indicate sepsis, commence the Sepsis Six care bundle
and contact the doctor and critical care outreach team
Sepsis management
Blood cultures
Two sets of blood cultures are recommended to improve microbial identification and sensitivity and, therefore, antibiotic choice. Cultures should be taken from
separate sites at the same time and should
include one from each intravenous device
in place for more than 48hours. Cultures
should also be taken from other sources,
for example sputum or urine.
Urinary output
Fluid balance is a good indicator of circulating volume and renal function, and
therefore essential for good sepsis management and the prevention of acute
kidney injury. Insertion of a urinary catheter is the gold-standard for accurate
measurement of urinary output but may
increase infection risk.
Oxygen
Fluids
Nursing
Times.net
patients with sepsis are significantly dehydrated so high levels of fluid resuscitation
are often needed. The SSC currently recommends 30ml/kg of crystalloids for
patients with hypotension or raised lactate
(>4mmol) (Dellinger et al, 2013). Lower volumes of fluid, given in intermittent
boluses, should be considered in uncomplicated sepsis and reviewed regularly for
efficacy. Lower volumes should also be
considered for those with active heart or
renal failure.
Antibiotics
Management plan
Conclusion