Table 2. Organ dysfunction criteria.

Cardiovascular dysfunction (≥1 of the following despite administration of isotonic intravenous fluid bolus ≥40 mL/kg in 1 hr)

Decrease in BP (hypotension) <5th percentile for age or systolic BP <2 SD below normal for age1 Need for vasoactive drug to maintain BP in normal range (dopamine >5 μg/kg/min or dobutamine, epinephrine, or norepinephrine at any dose) 2 of the following Unexplained metabolic acidosis: base deficit >5.0 mEq/L Increased arterial lactate >2 times upper limit of normal Oliguria: urine output <0.5 mL/kg/hr Prolonged capillary refill: >5 secs Core to peripheral temperature gap >3°C

Respiratory2 (≥1 of the following)

PaO2/FIO2 <300 in absence of cyanotic heart disease or preexisting lung disease PaCO2 >65 torr or 20 mm Hg over baseline PaCO2 Proven need3 or >50% FIO2 to maintain saturation ≥92% Need for non-elective invasive or noninvasive mechanical ventilation4

Neurologic (≥1 of the following)

Glasgow Coma Score ≤11 Acute change in mental status with a decrease in Glasgow Coma Score ≥3 points from abnormal baseline

Hematologic (≥1 of the following)

Platelet count <80,000/mm3 or a decline of 50% in platelet count from highest value recorded over the past 3 days (for chronic hematology/oncology patients) INR >2

Renal

Serum creatinine ≥ 2 times upper limit of normal for age or 2-fold increase in baseline creatinine

Hepatic (≥1 of the following)

Total bilirubin ≥ 4 mg/dL (not applicable for newborn) ALT 2 times upper limit of normal for age

blood pressure (BP), alanine transaminase (ALT), International normalized ratio (INR)

¹Please see Table 1;

²acute respiratory distress syndrome must include a PaO2/FIO2 ratio 200 mm Hg, bilateral infiltrates, acute onset, and no evidence of left heart failure. Acute lung injury is defined identically except the PaO2/FIO2 ratio must be 300 mm Hg;

³proven need assumes oxygen requirement was tested by decreasing flow with subsequent increase in flow if required;

⁴in postoperative patients, this requirement can be met if the patient has developed an acute inflammatory or infectious process in the lungs that prevents him or her from being extubated.

Adapted from reference 9