Adult Severe Sepsis

Sepsis Identification

Patients with suspected sepsis or septic shock and National Early Warning System Score (NEWS2) indicating medium risk (score 5 to 6) or high risk (Score 7 or higher). Refer to NEWS2 Scoring System Chart to calculate score.

Should not be used in patients under 16 years old or with pregnant women

Empiric Antimicrobial Therapy

Consider antibiotic history within the last 90 days and previous colonization or infections when selecting empiric therapy.

More Information

  • Blood cultures (aerobic and anaerobic) x 2 sets from 2 separate sites

    • Note: If patient has indwelling central venous catheter, take one set from each port and one from a peripheral vein
    • Draw before antibiotics, but do not delay antibiotics if cultures cannot be readily obtained
  • Urinalysis and urine culture

  • Sputum for culture if respiratory source suspected

  • Consider additional test and analysis depending on the presenting syndrome:

    • lumbar puncture
    • Nasopharyngeal swab for influenza or SARS-CoV-2
  • etc.

If not already completed:

  • CBC, electrolytes, CO₂, urea, creatinine, glucose random, PTT, PT/INR, bilirubin, ALT, Alk Phos, LDH

  • Venous blood gas, lactate (repeat every 2 hours x 2)

    • Goal: Lactate less than 2 mmol/L

  • Continuous cardiac monitoring

  • Vitals every 15 minutes for the first 6 hours

  • Chest x-ray

  • Electrocardiogram (ECG)

  • Consider additional imaging depending on the presenting syndrome

  • O₂ to keep SpO₂ greater than 88% (in patients with chronic respiratory conditions) or greater than 96%

  • Consider inserting urinary catheter with hourly urometer

  • Monitor intake and urinary output hourly

    • Goal: Urine output of 0.5 mL/kg/hour

Goal: 30 mL/kg in first hour for hypotension (MAP < 65 mmHg) OR lactate greater than or equal to 4 mmol/L

Central line preferred for ALL vasopressors, but do NOT delay start of therapy. It is permissible to initiate therapy with a peripheral line until such time that central access can be established

Start Infusion if Mean Arterial Pressure (MAP) less than 65 mmHg after 2L crystalloid

  • norepinephrine 0.01 to 1 mcg per kg per min IV infusion, titrate to maintain MAP 65 to 70 mmHg.

  • Note: Usual maintenance dose: 0.03 to 0.06 mcg per kg per min

  1. Consult ICU as early as possible
  2. Place central venous catheter (internal jugular or subclavian) when possible
  3. If a source of infection is identified that can be removed or drained, consult the appropriate service early
  4. Intubation if above goals are unobtainable OR hypoxemia is worsening
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