Adult Sepsis Management Algoritm

8/16/2019 Adult Sepsis Management Algoritm

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Note: Consider Clinical Trials as treatment options for eligible patients.

APPENDIX A: SUSPICION OF INFECTION

● Recent surgical procedure

● History of diabetes mellitus

● Immunocompromise

● Skin wound

● Invasive device

● Central line

● Foley catheter

● Infiltrate on chest x-ray

● Cough with sputum production

● Decreased perfusion (capillary refill greater than 3 seconds, skin mottling, cold extrem

lactate greater than 2 mmol/L)

● Circulatory (SBP less than 90 mmHg, MAP less than 65 mmHg, decrease in SBP grea

40 mmHg)

● Respiratory (PaO2/FiO2 less than 300; PaO2 less than 70 mmHg; SaO2 less than 90%)● Hepatic (jaundice; total bilirubin greater than 4 mg/dL; increased LFT’s; increased PT

● Renal (creatinine greater than 0.3 mg/dL; urine output less than 0.5 mL/kg/hour for at

2 hours)

● Central nervous system (altered consciousness, confusion, psychosis)

● Coagulopathy (INR greater than 1.5 or aPTT greater than 60 seconds); thrombocytope

(platelets less than 100,000/mm3)

● Splanchnic circulation (absent bowel sounds)

APPENDIX B: SUSPICION OF ORGAN DYSFUNCTION

APPENDIX C: ABBREVIATIONS

SIRS - Systemic Inflammatory Response Syndrome

ABG - Arterial blood gas

MAP - Mean arterial pressure 1/3 (SBP - DBP) + DBP

SpO2

- Pulse oximeter oxygen saturation

MERIT - Medical emergency response team

CVP - Central venous pressure

PRBC - Packed red blood cells

Scvo2 - Central venous oxygen saturation

APACHE - Acute Physiology and Chronic Health Evaluation

ALI/ARDS - Acute Lung Injury/Acute Respiratory Distress Syndrome

Department

Approved by The Executive Committee of th

This practice algorithm has been specifically developed for M. D. Anderson using a multidisciplinary approach and taking into consideration circumstances particular to M. D. Andersonincluding the following: M. D. Anderson’s specific patient population; M. D. Anderson’s services and structure; and M. D. Anderson’s clinical information. Moreover, this algorithm is nintended to replace the independent medical or professional judgment of physicians or other health care providers.This algorithm should not be used to treat pregnant women.

Copyright 2013 The University of Texas M.D. Anderson Cancer Center


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SUGGESTED READINGS

Kumar, A., Roberts, D., Wood, K. E., Light, B., Parillo, J. E., Sharma, S., ...Cheang, M.. Duration of hypotension before initiation of effective antimicrobial

therapy is a critical determinant of survival in human septic shock. (2006) Critical Care Medicine, 34(6), 1590-96.

Dellinger, R. P., Levy, M. M., Annane, D., Gerlach, H., Opal, S. M., Sevransky, J. F.,…Vincent, J. L., (2013). Surviving Sepsis Campaign: International

guidelines for the management of severe sepsis and septic shock, 2012. Intensive Care Medicine, 32(2), 165-228. doi: 10.1186/2110-5820-3-7

Hollenberg SM, Ahrens TS, Annane D, Astiz ME, Chalfin DB, Dasta JF, ...Zanotti-Cavazzoni, S. (2004). Practice parameters for hemodynamic support of sep

in adult patients: 2204 update. Critical Care Medicine, 32, 1928-1948.


Department


This practice algorithm has been specifically developed for M. D. Anderson using a multidisciplinary approach and taking into consideration circumstances particular to M. D. Andersonincluding the following: M. D. Anderson’s specific patient population; M. D. Anderson’s services and structure; and M. D. Anderson’s clinical information. Moreover, this algorithm is nintended to replace the independent medical or professional judgment of physicians or other health care providers.This algorithm should not be used to treat pregnant women.



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DEVELOPMENT CREDITS

Bruno Palma Granwehr, MD

Susan Gaeta, MDŦ

Josiah Halm, MD

Maggie B. Lu, PharmD

Imrana Malik, MD

Joseph L. Nates, MD MBAEgbert Pravinkumar, MD

Sharla K. Tajchman, PharmD

Katy M. Toale, PharmD

Mary Lou Warren, RN MS

Department o


This practice algorithm has been specifically developed for M. D. Anderson using a multidisciplinary approach and taking into consideration circumstances particular to M. D. Anderincluding the following: M. D. Anderson’s specific patient population; M. D. Anderson’s services and structure; and M. D. Anderson’s clinical information. Moreover, this algorithm intended to replace the independent medical or professional judgment of physicians or other health care providers.This algorithm should not be used to treat pregnant women.

This practice consensus algorithm is based on majority expert opinion of the Sepsis Work Group at the University of Texas M.D. Anderson Cancer CenteIt was developed using a multidisciplinary approach that included input from the following core development team..


ŦPhysician Lead


Adult Sepsis Management Algoritm

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