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Table 1 Summary of key aspects in our bundled care initiative

From: Unexpected intensive care transfer of admitted patients with severe sepsis

Identification:
 A. Any 2 of the following (at least 2 required)
  (1) Temp >38.3 °C (100.9 °F) or <36.0 °C (96.8 °F)
  (2) Heart rate >90/min
  (3) Respiratory rate >20 breaths per min
AND
 B. Evidence of hypoperfusion (at least 1 required)
  (1) MAP <65 mmHg
  (2) SBP 40 mmHg below baseline
  (3) Acutely altered mental status
  (4) Oxygen saturation <92%
  (5) Exam suggestive of hypoperfusion
AND
 C. Suspected infection source
 Management:
   Phase 1:
    Ensure adequate intravenous access
    Weight-based IV fluid bolus
    Repeat serum lactate 3 h after first specimen obtained
    Administer broad-spectrum IV antibiotics in parallel
    If persistent hypotension OR failure to clear lactate by 10%,     start phase 2
   Phase 2:
    Obtain central venous access
    Obtain ScvO2
    Transduce CVC to measure a CVP
    Insert arterial catheter
    Additional volume resuscitation
    Begin vasopressor
    Contact nursing/house supervisor and ICU team
    Serial lactate and Scv02 (every 6 h)
    Consider transfusion to hematocrit of 30 if ScvO2 < 65% after     volume resuscitation and pressor initiation
    Consider corticosteroids if vasopressor-dependent hypotension