Appendix 1 - Table 5.

Project IMPACT Definitions for Organ Failures

Organ System	Definition of Failure
Cardiovascular	Any of the following for >1 h despite adequate fluid resuscitation: SBP <90 mmHg (unless known baseline is <90) SBP ↓ 40 mmHg from baseline MAP <70 mmHg Vasopressors (dopamine equivalent >5 mcg/kg/min) need to keep SBP >90 mmHg or MAP>70 mmHg
Hyperlactatemia	Both of: Cardiovascular organ failure (by above criteria) Serum lactate > upper limits of normal for local laboratory
Respiratory	Noncardiogenic pulmonary edema
	and
	Either of: PaO2/FiO2 ≤300 PEEP >5 mmHg
Renal	Patient not on chronic dialysis
	and
	Either of: Serum creatinine ↑ by 1mg/dl above baseline after adequate fluid resuscitation Serum creatinine ≥ 2 mg/dl if no known baseline
Hematologic	Any of: Platelets ↓ to ½ the highest value of the previous 3 days Platelets < 100,000/mm3 PT or PTT > 1.5× control (not due to anticoagulation therapy)
Hepatic	Serum total bilirubin >2 mg/dl (must be acute, not chronic)
Neurologic	All of: Acutely altered sensorium No known CNS injury or insult Sedation holiday performed No tracheal intubation GCS ≤12

CNS = central nervous system; FiO2 = fraction of inspired oxygen; GCS = Glasgow coma score; MAP = mean arterial pressure; PaO2 = partial pressure of oxygen in the arterial blood; PEEP = positive end-expiratory pressure; PT = prothrombin time; PTT = partial thromboplastin time; SBP = systolic blood pressure.