Sepsis, N/IICU — Evaluating Signs/Symptoms Concerning for Infection — Clinical Pathway: ICU and Inpatient

Suspected Sepsis Clinical Pathway — N/IICU

Evaluating Signs/Symptoms Concerning for Infection

With all signs/symptoms, consider contacting FLOC to request a bedside huddle. FLOC and RN should discuss if sign/symptom is a change from baseline and any possible alternative causes.

Temperature and Heart Rate Abnormalities

Temperature Abnormalities
  • > 38 or ≤ 36°C
  • Change in incubator support from baseline
  • Note:
    • Antipyretic use may mask fever
    • Even if temperature change attributed to environment, continue to monitor for additional signs/symptoms of infection
Heart Rate Abnormalities

Organ Dysfunction

Changes in Respiratory Status
  • Cardiorespiratory events (apnea, bradycardia, desaturations) – evaluate change from baseline
  • Increased respiratory support and/or oxygen requirements
Perfusion Abnormalities
  • Cold sepsis/shock:
    • Cool extremities
    • Capillary refill > 3 sec
    • Diminished pulses
    • Mottling
  • Warm sepsis/shock:
    • Flushed
    • Warm extremities
    • Bounding pulses
    • Flash capillary refill
  • Decreased urine output
Hypotension
Changes in Neurologic Status
  • Change in mental status (lethargy, irritability, decreased responsiveness)
  • Decreased tone
  • Seizures
Coagulation Abnormalities
  • New bleeding/oozing
  • Thrombocytopenia
  • Altered coagulation profile
  • DIC
  • Petechial, purpuric rash

Other Signs/Symptoms

Changes in Feeding Tolerance
  • Ileus
  • Feeding intolerance (emesis, abdominal distention)
Lab Values Concerning for Infection
  • CBC findings (in absence of other reasons for alteration):
    • Leukopenia (WBC < 5000 cells/cu.mm) or leukocytosis
    • Neutropenia (ANC < 1500 cells/cu.mm)
    • Left shift (presence of bands and other immature forms such as myelocytes, promyelocytes and metamyelocytes)
    • Immature: total neutrophil (I:T) ratio > 0.2 moderate thrombocytopenia (platelet count < 100,000 cells/cu.mm)
    • CRP > 1.5 mg/dL (in absence of other reasons for alteration)