Severe sepsis and septic shock protocol (Proceedings)

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Severe sepsis and septic shock protocol (Proceedings)

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Apr 01, 2009

Definitions


Follow the clocks for an approximate time line after entering protocol at 12:00!
Systemic inflammatory response may be present in animals with a consistent history and clinical characteristics, and with any 3 or more of the following findings:
  • resting HR > 140 (dog) or > 220 (cat) or < 160 (cat)
  • resting respiratory rate > 30
  • Injected or pale grey mucous membranes
  • warm skin
  • hypo- or hyperthermia
  • leukocytosis or leucopenia
  • thrombocytopenia

Sepsis syndrome is a systemic inflammatory response due to bacterial infection and is categorized, in order of increasing severity, as:

  • Sepsis: A systemic inflammatory response due to bacterial infection. Protocolized therapy not needed. Address underlying infection and monitor response.
  • Severe sepsis: Sepsis with hypotension (MAP < 70 mm Hg) that responds to supportive care and fluid therapy without vasopressors. Enter protocol
  • Septic Shock: Sepsis with hypotension unresponsive to fluid therapy and requiring vasopressors. Enter protocol

Acute Care Therapeutic Targets

Dogs

  • HR < 140 BPM
  • Temperature > 38o C
  • Normal, bounding, or improved pulse
  • Normal-to-injected mucus membrane color
  • Warm skin
  • CRT < 2 seconds
  • Noninvasive arterial pressure systolic (SAP) > 140 mm Hg, mean (MAP) 80-90 mmHg
  • Direct MAP 80-90 mm Hg, diastolic blood pressure (DBP) > 60 mm Hg
  • Urine output > 1-2 ml/kg/hour
  • Alert, oriented mentation
  • Appropriate CVP response to fluid challenge
  • Normoglycemia
  • Arterial blood gas analysis: pO2 > 90 mm Hg, pCO2 25 – 35 mm Hg, lactate concentration < 2.5 mmol

Cats

  • HR > 160 BPM
  • Temperature > 38o C
  • Palpable or improved pulse
  • Normal-to-injected mucus membrane color
  • Warm skin
  • CRT < 2 seconds
  • Noninvasive arterial pressure systolic (SAP) > 120 mm Hg, mean arterial pressure (MAP) 80-90
  • Direct MAP 80-90 mm Hg, diastolic blood pressure (DBP) > 60 mm Hg
  • Urine output > 1-2 ml/kg/hour
  • Alert, oriented mentation
  • Appropriate CVP response to fluid challenge
  • Normoglycemia
  • Arterial blood gas analysis: pO2 > 90 mm Hg, pCO2 25 – 35 mm Hg, lactate concentration < 2.5 mmol

Step 1: Characterize patient condition and begin instrumentation




Monitor with ECG, pulse oximetry
  • Large-bore peripheral catheter
  • Central venous catheter: Consider a double- or triple-lumen catheter
  • Collect blood for:

o CBC
o chemistry profile
o Big 4 (PCV, TS, glucose, BUN)
o Arterial (or central venous) blood gas
o Coagulation profile and/or a baseline aPTT on the SCA 2000
  • If SPO2 is < 90% or if increased respiratory effort is present: oxygen by face mask