Sepsis Management

Diagnosis

Initial Management

Reassessment

Note: The BlueWater sepsis care quality bundle has the following components for care of patients with severe sepsis or septic shock:

Care Requirement Severe Sepsis Bundle Septic Shock Bundle
Initial Lactate Level Required within 3 hours of Time Zero Required within 3 hours of Time Zero
Blood Cultures Required within 3 hours (prior to IV antibiotics) Required within 3 hours (prior to IV antibiotics)
Broad Spectrum Antibiotics Required within 3 hours Required within 3 hours
30mL/kg IV Fluid Bolus Not automatically required. Only triggered if the initial lactate is ≥4.0 mmol/L Mandatory within 3 hours of shock identification
Vasopressor Therapy Never required (by definition, these patients are not in shock) Mandatory within 6 hours if hypotension persists after the fluid bolus
Repeat Lactate Level Required within 6 hours only if the first lactate was elevated (>2.0 mmol/L) Required within 6 hours only if the first lactate was elevated (>2.0 mmol/L)
Focused Perfusion Reassessment Never required for severe sepsis alone Mandatory within 6 hours of shock identification

SIRS Criteria (≥ 2 Required)

  • Temperature > 38°C or < 36°C
  • Heart rate > 90 bpm
  • Respiratory rate > 20 or PaCO₂ < 32 mmHg
  • WBC > 12,000, < 4,000, or > 10% bands

Sepsis

  • Suspected or confirmed infection AND
  • ≥ 2 SIRS criteria

Severe Sepsis

  • Sepsis AND evidence of acute organ dysfunction, such as:
    • Hypotension (SBP<90 or MAP <65)
    • Lactate ≥ 2 mmol/L
    • Creatinine >2.0 or oliguria
    • Platelets < 100,000
    • Bilirubin > 2 mg/dL
    • Acute respiratory failure (Vent or BiPAP)
    • INR > 1.5 (not on anticoagulation)

Septic Shock

  • Severe sepsis AND either:
    • Persistent hypotension (2 readings w/in 6h SSPT)
    • Lactate ≥ 4 mmol/L even if blood pressure is normal