Investigations for sepsis

Question 1

What are the appropriate investigations when sepsis is suspected

Answer 1

• Blood cultures
• Serum lactate ≥4 mmol/l is indicative of tissue hypoperfusion, taken within 6 hours
• Any relevant imaging studies

Question 2

Tasks to be performed within the first six hours of the identification of severe sepsis

Answer 2

• Blood cultures prior to antibiotics
• Administer broad-spectrum antibiotic within one hour
• Measure serum lactate
• If hypotension and/or a serum lactate >4mmol/l minimum 20ml/kg of crystalloid or an equivalent.
• Apply vasopressors for hypotension that is not responding to initial fluid resuscitation to maintain mean arterial pressure (MAP) >65mmHg
• If persistent hypotension despite fluid resuscitation (septic shock) and/or lactate >4mmol/l:
  a. Achieve a central venous pressure (CVP) of ≥8mmHg
  b. Achieve a central venous oxygen saturation (ScvO2) ≥ 70% or mixed venous oxygen saturation (ScvO2) ≥ 65%