Christine, i agree with you there needs to be more clarity. perhaps some of the members of the group that wrote the guidelines might want to comment.
some might say that if the septic patient does not respond to initial few hours of efforts, fluids, etc. and their remain some indication of organ function, UO is still low, mentation remains below normal, ScvO2 is low, etc. then then the patient has severe sepsis. if BP becomes low you have septic shock. it would be great to have a decision tree flow chart of this. g On Nov 22, 2014, at 8:40 PM, Medical <[email protected]<mailto:[email protected]>> wrote: Sent from my iPhone 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 _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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