Organ dysfunction variables

Arterial hypoxemia (Pa02/FI02 <300)

Acute oliguria (urine output <0.5 ml/kg/hr for at least 2 hrs,

despite adequate fluid resuscitation)

Creatinine increase >0.5 mg/dL

Coagulation abnormalities (INR >1 .5 or a PTT > 60 sees)

Ileus (absent bowel sounds)

Thrombocytopenia (platelet count, <100,000/�L)

Hyperbil irubinemia (total bilirubin >4 mg/dL)

Tissue perfusion variables

Hyperlactatemia (>4 mmoi/L)

Decreased capillary refill or mottling

Diagnostic criteria for sepsis in the pediatric population are signs

and symptoms of inflammation plus infection with hyper- or

hypothermia (recta l temperature > 38.5°C or <35°C), tachyca rd ia

(may be a bsent in hypothermic patients), and at least one of the

fol lowi ng indications of altered organ function: altered mental

status, hypoxemia, in creased serum lactate level, or bounding

pulses.

INR, i nternational normal ized ratio; MAP, mean arterial pressure;

PTI, activated partial thromboplastin time; SBP, systolic blood

pressure; so, sta ndard deviation; WBC, white blood count.

Adapted from Levy MM, Fink MP, Marshall JC, et al: 2001 SCCM/

ESICM/ ACCP I ATS/SIS I nternational Sepsis Definitions Conference,

Crit Core Med 2003;3 1 :1 250-1 256

attempt to augment cardiac output. Tachypnea may be a

sign of hypoxia or may represent respiratory compensation

of a metabolic (lactic) acidosis. "Normal" blood pressures

should not be used as an indication of stability. Shock is

defined as an SBP <90 mmHg or 40 mmHg below one's

SEPSIS

Table 34-2. Diagnostic criteria for severe sepsis.

Severe sepsis is sepsis with tissue hypoperfusion or organ

dysfunction as defined by the following criteria:

Hypotension

Lactate greater than the upper limits of normal laboratory results

Urine output <0.5 ml/kg/hr for > 2 hrs, despite adequate fluid

resuscitation

All with Pa02/FI02 <250 in the absence of pneumonia

All with Pa02/FI02 <200 in the presence of pneumonia

Creatinine >2.0 mg/dL

Bil irubin >2 mg/dL

Platelet count <100,000/�L

Coagulopathy (INR > 1 .5)

All, acute lung inju ry; I NR, international norma lized ratio.

Data from Levy MM, Fink MP, Marshall JC, et al: 2001 SCCM/ESICM/

ACCP I ATS/S IS International Sepsis Defin itions Conference, I ntensive

Care Med 2003;29:530-538. ACCP /SCCM Consensus Conference

Committee: American College of Chest Physicians/Society of

Critica l Care Medicine Consensus Conference: Definitions for sepsis

and organ fa ilure and guidelines for the use of innovative therapies

in sepsis, Crit Core Med 1 992;20:864-87 4

baseline blood pressure, despite two 20- to 30-mL/kg

boluses. (That's 4-6 L for a 100-kg patient!) Patients, family

members, and electronic medical records can be useful in

determining baseline blood pressures.

A detailed physical exam starts with general appearance, head and neck, respiratory, cardiovascular, abdominal,