This document outlines a proposed protocol to rapidly identify and treat sepsis in patients. The protocol was developed based on evidence that sepsis accounts for over 200,000 deaths in the US each year and remains a leading cause of death in ICUs. The protocol aims to educate nurses to identify sepsis using specific criteria, and to treat patients according to a treatment algorithm that aims to meet goals such as central venous pressure of 8-12 mmHg within 12 hours in order to reduce mortality. The proposed study would assess if implementing this protocol including obtaining immediate serum lactate levels on high-risk emergency department patients aged 18+ reduces mortality from sepsis.

2. Purpose
Develop an evidenced based protocol that will allow
rapid identification of sepsis and to educate and
empower nurses to use the protocol to manage patients
with severe sepsis

3. Background
Sepsis is a complex condition that
is often life-threatening. It is
characterized by hematological
disorders and a pronounced
inflammatory response to an
infection or injury. Sepsis accounts
for 215, 00 deaths in the United
States each year at a cost of more
than $16 billion. Septic shock
remains the most frequent cause of
death in non-cardiac ICU’s
0
50
100
150
200
250
Thousandsofdeaths/year
Cause of death
Picard, O'Donoghue, Young-Kershaw, & Russell, 2006

4. Methods
Identification of patient’s with suspected infection
Patients > 18 yrs.
Within one hour of admission
Level 1 emergency room

5. Inclusion Criteria
Patients > 18yrs or older with signs/symptoms of infection
Meets two or more of the following for systemic inflammatory
response syndrome:
Temperature > 100.4 F or < 96.8 F
Heart rate > 90 beats/min
Respirations > 32.min or Paco2 <32 mm Hg
White blood count > 12,000 cells/mm3 or < 4,000 cells/mm3

6. Protocol
Central line insertion
with continuous Scvo2
monitoring
Broad Spectrum ABX
CVP
<8-12
500 mL NS bolus
Repeated q 20-30min
until CVP >8 mm Hg
Monitor lungs sounds
for tolerance of
boluses
MAP
<65
Initiate Norepinephrine
drip
Titrate for a MAP > 65
mm Hg
Scvo2
< 70%
Hematocrit
< 30% Tranfuse 1 unit
PRBC
Repeat Hgb and
Scv02 2hrs after blood
transfusion
> 30% Initiate
dobutamine drip Titrate every 1 hr for
Scvo2 > 70%
Supplemental oxygen
or mechanical
ventilation

7. Results
300 patients >18yrs
24 months of data collection by trained nurses
Serum lactate

8. Educating Staff
In service programs
Grand rounds
Poster size sepsis protocol
24hr on call nurse

9. Outcomes-Success
Goals of therapy will be met within 12hrs
Central Venous Pressure (CVP) 8-12 mm Hg
Mean Arterial Pressure (MAP) 65-90 mm Hg
Mixed Venous Oxyhemoglobin (Scvo2) 70%-80%
Hematocrit > 30%
Serum lactate < 4mmol

10. Barriers
Educating a large staff working various shifts.
Transferring patients treated by using the protocol in
a timely manner.
Expediting placement of central venous catheters.
Equipment issues.

11. Summary
Will obtaining serum lactate levels immediately on
emergency department (ED) patients, age 18 and older,
meeting certain sepsis high-risk prognostic criteria,
reduce mortality due to immediate treatment
interventions.

12. Thank You!
Reference
Picard, K. M., O'Donoghue, S. C., Young-Kershaw, D. A., & Russell, K. J. (2006).
Development and implementation of a multidisciplinary sepsis protocol.
Critcal Care Nurse, 26(3), 43-54.
Shapire, N., Fisher, C., Donnino, M., Cataldo, L., Tang, A., Trzeciak, S., Horowitz, G., &
Wolfe, K. (2010) The feasibility and accuracy of point-of-care lactate measurement
in emergency department patients with suspected infection. Journal of
Emergency Medicine 39(1), 89-94.
Shapiro, N. I., Howell, M. D., Talmor, D., Lahey, D., Ngo, L., Buras, J., . . . Lisbon, A.
(2006). Implementation and outcomes of the Multiple Urgent Sepsis
Therapies (MUST) protocol. Critical Care Medicine, 34(4), 1025-1032.