Aggressive treatment of Sepsis

The earliest treatment of sepsis treatment is PREVENTING the infection in the first place.

Initiatives  are being used to help prevent infection. Initiatives includes bundles such as the central line insertion bundles and foley catheter insertion bundle.

However despite our great care- patients can present with or develop sepsis.

Once sepsis has been identified early- we are ready for the next step: Treatment

Nurses play a key role in treatment of sepsis. 



Within three hours the following items must be completed:

• Obtain lactate level
• Obtain pan cultures- blood culture, urine culture and obvious wound cultures. If obtaining cultures takes longer than 45 minutes to start antibiotics without obtaining all cultures.
• Obtain a blood culture from lines greater than 48 hours old to rule out line infection.
• One blood culture should always be drawn peripherally.
• Administer broad spectrum antibiotics.
• Administer large amounts of crystalloid fluid (Normal Saline used most commonly) quickly- 30ml/kg at a minimum for hypotension or lactate level ≥4mmol/L.
• IV fluids boluses should continue if patient responds hemodynamically.
• Monitor glucose levels- initiate critical care glucose protocols. Maintain glucose levels less then 180 mg/dl.
• Imaging studies maybe used to help determine source of infection.

Within six hours the following items must be completed:

• Vassopressors for hypotension after fluid volume has been replenished.
• Norepinephrine first choice vassopressor
• Repeat lactate level- goal is to be normalized.

 



Mean arterial pressure (MAP) ≥ 60mmg Hg

CVP reading greater the 8- 12 mmHg

Central venous oxygen saturation (ScvO2)  reading greater > 70%

Urine output ≥ 0.5ml//kg/hr

Special Considerations

Pediatrics require special consideration. See the attached link for further information on pediatric sepsis care.
Providing patients and families with education regarding sepsis is very important. Families and patients must understand the severity of the illness. Sepsis can lead to multi-organ failure.  Treatment of sepsis needs to be aggressive. Discussion with families and patients should include palliative care/end of life care decisions and the patient’s wishes regarding aggressive treatment.
 
Providing aggressive treatment is another key part of Surviving Sepsis.