Table 1.

Summary of key aspects in our bundled care initiative

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