SSC in ITU: Resuscitation Bundles

Clinical scenario

Patient with severe sepsis presents to the ITU.

Audit question

Are we meeting the criteria suggested in the Surviving Sepsis Resuscitation bundles.

Method

Retrospective audit of consecutive cases admitted to ITU with a diagnosis of sepsis ie. 2 or 4 SIRS Criteria and evidence of infection (highly suspicious of infection).


Resuscitation bundle defined as:





Serum lactate measured.





Blood cultures obtained prior to antibiotic administration.


From the time of presentation, broad-spectrum antibiotics administered within 3 hours for ED admissions and 1 hour for non-ED ICU admissions.





In the event of hypotension and/or lactate > 4mmol/L (36mg/dL):


Deliver an initial minimum of 20 ml/kg of crystalloid (or colloid equivalent)


Give vasopressors for hypotension not responding to initial fluid resuscitation to maintain mean arterial pressure (MAP) > 65 mm Hg.


In the event of persistent arterial hypotension despite volume resuscitation (septic shock) and/or initial lactate > 4 mmol/L (36 mg/dl):


Achieve central venous pressure (CVP) of > 8 mm Hg.


Achieve central venous oxygen saturation (ScvO2) of > 70% .*

Comments

Audit standard should be 95%.
More info at www.survivingsepsis.com

Audit Bottom Line

In progress

Record created on 28th March 2006 by John Butler