Sepsis

Sepsis is “life-threatening, organ dysfunction caused by a dysregulated host response to infection” with a SOFA score ≥2.

• Septic shock is “a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone”, identified clinically by a vasopressor requirement to maintain a MAP ≥ 65 and serum lactate ≥ 2 mmol/L in the absence of hypovolemia.
• If you are still unsure if your patient is septic or not after calculating the NEWS, obtain a serum lactate early.

But it is very nonspecific and there are many false positives including any type of shock, ischemia, liver failure, seizures, Type B Lactic Acidosis from many drugs including Ventolin/Salbutamol.

Lactate is not a direct marker of end organ mal perfusion/tissue hypoxia. Early lactate increase in early sepsis is due to increase sympathetic response. Lactate group received more fluids, more vasopressors, more inodilators (when u do more stuff they get worse)

• Send Lactate early
• If its high use it to guide resuscitation. Trend it several hours (2 hours….)
• Marker of badness (next lactate higher-under resuscitation or missing something à get serious or call for help

Procalcitonin as a diagnostic marker for sepsis and septic shock

procalcitonin levels in early stages of sepsis are significantly lower among survivors as compared with non-survivors of sepsis.

cutoff of 0.41 ng/dL had a sensitivity of only 75% and specificity of 64% for sepsis.

A prospective, observational cohort ICU study of patients with severe sepsis and septic shock found that 24- and 48-hour procalcitonin clearance scores were significantly higher in survivors.

1 hour bundle

Surviving sepsis 2018 update combined 3 hour and 6 hour bundles in to 1 hour bundle.