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> >> >> My name is Dr. Christine Miyake, I have a question about the diagnosis of >> severe sepsis. My understanding from the details of all of the >> recommendations including the 2012 document that severe sepsis is defined as >> sepsis with one or more acute organ dysfunction OR a lactate greater than 4. >> But in the guidline below it does not mention organ dysfunction. Because >> of this the new hospital I am working for only uses and elevated lactate or >> hypotension despite fluids to determine severe sepsis, this seems very wrong >> to me. My understanding was you could have severe sepsis with organ >> dysfunction and a normal lactate in some cases but they still would require >> bundle implementation. Any thoughts, comments, clarification? >> >> Recommendations: Initial Resuscitation and Infection Issues* >> >> A. Initial Resuscitation >> >> 1. Protocolized, quantitative resuscitation of patients with sepsis-induced >> tissue hypoperfusion (defined in this document as hypotension persisting >> after initial fluid challenge or blood lactate concentration >> >> ≥ 4 mmol/L). Goals during the first 6 hrs of resuscitation: >> a) Central venous pressure 8–12 mm Hg >> >> b) Mean arterial pressure (MAP) >> >> ≥ 65 mm Hg c) Urine output ≥ 0.5 mL/kg/hr d) Central venous (superior vena >> cava) or mixed venous oxygen saturation 70% or 65%, respectively (grade 1C). >> 2. In patients with elevated lactate levels >> >> >> >> Christine
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