ICU Pathway for the Evaluation/Treatment of Infants > 28 Days and Children with Severe Sepsis/Septic Shock

Recommended Laboratory Studies

BLOOD Frequency Comment
Blood Culture*   Obtain prior to antibiotics when possible, but do not delay antibiotic administration
ABG Supergas w/ionized Ca, lactate Q 2hr, prn  
VBG Supergas w/inonized Ca Q 2hr, prn

If no arterial line

Draw from CVL
Venous Co-oximetry Q 2hr, prn

Preferentially drawn from CVL with tip at SVC/RA junction
Results from femoral lines may be less reliable, trends are useful

POC Surestrip glucose Q 2hr If not checking glucose via blood gas
CBC, differential Q 12hr, prn  
PT/INR/PTT, fibrinogen Q  12hr, prn  
BMP Q 12hr, prn  
Mg Q 12hr, prn  
Phos Q 12hr, prn  
Amylase, lipase Q 24hr, prn  
Hepatic function panel Q 24hr, prn  
CRP Q 24hr  
Type and Screen Q 72 hr  
Cortisol Random

Send if risk of adrenal insufficiency

  • Catecholeamine resistant shock
  • Purpura fulminans
  • Congenital adrenal hyperplasia
  • Prolonged steroid treatment (> 2 weeks)
URINE
Urinalysis, culture    
Urine HCG once Females > 12 years
OTHER
Respiratory Gram Stain, culture   If ETT, tracheostomy
Respiratory PCR Panel   If URI symptoms, signs
Enteroviral Studies  

June – October
PCR of blood, urine and CSF (if obtained)

Stool culture, routine   As clinically indicated
CSF profile, gram stain, culture   As clinically indicated
Mycoplasma PCR  

Consider if pneumonia present
PCR from blood, naso pharyngeal aspirate

Rocky Mountain PCR   Consider if petechial/purpuric rash, hyponatremia, low platelets,  PCR blood

*Blood cultures are ideally drawn prior to antibiotic administration. While blood culture is currently the gold standard for blood stream infection, sensitivity is greatly affected by collection site and technique, number of cultures, volume of blood drawn, and interpretation of results (timing and pathogen).

Buttery, Arch Dis Child Fetal Neonatal Ed 2002; 87:F25-F28.