Sepsis Definition
In Non-Coronary intensive care units within the United States, sepsis is the leading cause of death Current estimates place the mortality rate between 28 and 50%. Sepsis, however, does not refer to a specific bacteria, but rather to the body’s immune response to an overwhelming infection. Infections, at any point on the body, can lead to sepsis. In hospitals, common sites of the initial infection include IV catheters, surgical sites, and pressure ulcers.
Pathophysiology
Within normal circumstances, the body’s immune response seeks to increase blood flow and the capabilities of macrophanges to control an infection. .
In response to the foreign antigen, the body releases pro-inflammatory mediators such as prostaglandins, tissue necrosis factor, cytokines, and platelet-activating factors. These mediators damage the delicate endothelial lining, leading to capillary leakage. Additionally, they activate neutrophils (which release nitric oxide) and lead to edema. Platelet-activating factors begin to circulate systematically, and coagulation is increased. Together, these effects create symptoms of hypotension, edema, and microthrombi which impair the perfusion of tissues and lead to multi-organ failure.
Signs and symptoms
Hypothermia, tachycardia, tachypnea, peripheral vasodilation/edema, unexplained shock, and unexplained mental status changes all can indicate sepsis. The CBC will indicate infection and clotting factors will be noted.
Prevention
The only way to reduce the incidence of sepsis is to prevent infection. Strict adherence to policies regarding IV site care and careful monitoring and treatment of surgical site infections are the best way to prevent healthcare-associated infections leading to sepsis.
Surviving Sepsis
Sepsis Bundles are evidence-based clinical recommendations for the treatment of sepsis and septic shock. Originally introduced by The Surviving Sepsis Campaign, these bundles have proven to be effective when used together to combat sepsis.
The term “bundle” refers to a series of evidence based protocols that are used together. When implemented together, these elements have greater results than any of the interventions used alone. Hospitals are meant to use the bundles as a framework for creating sepsis protocol in their institutions.
What’s in the Bundles?
Once a patient is triaged in the ED or identification is made of symptoms consistent with severe sepsis, the following steps are to be taken:
TO BE COMPLETED WITHIN 3 HOURS:
1) Labs: Lactate levels
2) Obtain blood cultures
3) Administer broad spectrum antibiotics after blood cultures are done
4) Give 30 ml/kg of crystalloid for hypotension or lactate =4 mmol/L
TO BE COMPLETED WITHIN 6 HOURS:
5) Give vasopressors (for hypotension not responding to initial fluid resuscitation) to maintain a mean arterial pressure (MAP) =65 mmHg
6) In the event of persistent hypotension after fluid resuscitation (MAP < 65 mm Hg) or if initial lactate was =4 mmol/L, re-assess volume status and tissue perfusion and document findings
7) Re-measure lactate if initial lactate was elevated.
DOCUMENT REASSESSMENT OF VOLUME STATUS AND TISSUE PERFUSION WITH
- Repeat focused exam by independent licensed provider (vital signs, assessment of perfusion, fluid status)
OR TWO OF THE FOLLOWING:
- CVP
- ScvO2
- Bedside cardiovascular ultrasound
- Assessment of fluid responsiveness using passive leg raise (does the patient show an increase in stroke volume?)
Successful implementation should strive for a twenty five percent reduction in mortality from Sepsis within their organization
Interested in learning more about evidenced based nursing care. CNE Explorer is a US based online provider of continuing education for nurses and provides online CE courses to nurses around the world.
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