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

Vital Sign Targets and Clinical Goals

Age-Related Vital Sign Targets

Age Heart Rate SBP MAP DBP
0 to 30 days 100-160 >60 >40 >30
31 days to < 1 year 100-160 >65 >45 >30
1 year to < 2 years 90-160 >70 >50 >35
2 to < 6 years <140 >75 >50 >40
6 to < 13 years <130 >85 >60 >45
≥ 13 years <110 >90 >65 >50

Clinical Goals for Initial Resuscitation

Parameter Comment Target
Heart Rate Tachycardia can be a sign of hypovolemia or ongoing shock;
Bradycardia can be a sign of shock
Age-related (see table above)
Systolic Blood Pressure (SBP) Arterial monitoring preferred Age-related (see table above)
Diastolic Blood Pressure (DBP) Arterial monitoring preferred Age-related (see table above)
Mean Arterial Blood Pressure (MAP) Arterial monitoring preferred Age-related (see table above)
Urine Output (UOP) Inadequate urine output is one sign of poor end-organ perfusion < 30 kg: > 1 ml/kg/hr
≥ 30 kg: ≥ 30 ml/hr
Central Venous Pressure (CVP) Most accurately measured from CVL with tip at the SVC-RA junction;
Femoral CVL, PICC and Broviac measurements less reliable, but trends may be useful
8-12 cm H20 (natural airway)
12-15 cm H20 (mechanical ventilation)
Lactate Elevated lactate > 4 mmol/L may be sign of shock with inadequate oxygen delivery (ref: Puskarich et al, Resuscitation, 2011 ) < 4 mmol/L or
≥ 10% decrease every 2 hours
Central venous oxygen saturation (ScvO2 or venous co-oximetry) Most accurately measured from CVL with tip at the SVC-RA junction or long femoral line with tip near RA ≥ 70%
Note: Elevated ScvO2 (> 80%) may occur in sepsis due to "cytopathic hypoxia" despite ongoing shock
Hemoglobin Hemoglobin is a primary determinant of O2 delivery; thus, anemia should be treated in shock. Patients NOT in shock may tolerate a lower Hgb level of 7 Hgb ≥ 10 g/dL (for patients in shock
- ScvO2 < 70%, lactate > 4 mmol/L)

Hgb > 7 g/dL (after resolution of shock)
Mental Status Lethargy, confusion, agitation is one sign of poor end-organ perfusion Alert and appropriate for age
Capillary Refill Flash capillary refill can be seen in warm shock, delayed capillary refill can be seen in cold shock < 2 seconds