Sepsis, Suspected — Patient Cohort — Clinical Pathway: CICU/CCU

Suspected Sepsis Clinical Pathway — CICU/CCU

Patient Cohort

General Description

This pathway should be used to guide the care of patients of all ages (neonates to adult) in the CICU/CCU for whom there is a new concern for infection with possible sepsis, severe sepsis or septic shock.

Identifying Children at Risk for Severe Sepsis/Septic shock

The following criteria may be present at baseline for patients with congenital heart disease. However, the presence or worsening of these symptoms should raise clinical suspicion for evolving severe sepsis or septic shock. Patients with severe sepsis/septic shock have an infection which triggers an exaggerated immune response that causes inadequate tissue perfusion leading to organ failure. Hypotension is a late finding. Early recognition and goal-directed therapy improves patient outcomes.

Temperature Abnormality < 56 days   T > 38° C
> 56 days   T > 38.5° C
All ages      T < 36° C
  • If there is concern about the accuracy of the patient’s axillary temperature, check the patient’s core temperature
  • Fever height and duration should be considered on a case-by-case basis in conjunction with the patient’s pertinent history and physical findings
Heart Rate Abnormality Age Tachycardia
(> 95th percentile)
1 mo to 1 yr > 180
> 2-5 yrs > 140
> 6-12 yrs > 130
> 13-18 yrs > 120
Mental Status Abnormality Anxiety, restlessness, agitation, irritability, inappropriate crying, drowsiness, confusion, lethargy, obtundation
Perfusion Abnormality Cool extremities, capillary refill > 3 seconds, diminished pulses, mottling or flushed, warm extremities, bounding pulses, flash capillary refill

Exclusion

Well appearing, non-toxic patients undergoing evaluation for bacterial endocarditis; where identifying the pathogen is more important than timely antibiotics.

Fever occurring within 48 hours of surgery in patients that have no other high risk conditions for sepsis; post-op fever is very common.