The identification and use of common physiologic monitoring parameters in the care of critically ill patients at risk for sepsis

Background

Sepsis is a common source of morbidity and mortality among critically ill patients. Targeting measures to reduce the incidence of and to promote early recognition and treatment of sepsis is at the forefront of many critical care initiatives. Advances in the management of severe sepsis have evolved over recent years in an attempt to combat the spiraling mortality trends. The Surviving Sepsis Campaign (SSC) is a worldwide initiative promoting the evidence-based treatment of sepsis, with the explicit goal of reducing both the morbidity and mortality associated with sepsis. This study was conducted to assess the clinical relevance of the early physiologic screening criteria advocated by early goal-directed therapy for sepsis, and the Surviving Sepsis Campaign guidelines.

Materials and methods

The Project IMPACT^® database was used to obtain a sample of patients (n = 363) with an ICU admission diagnosis of sepsis and a random acuity-matched comparison sample of patients with an admission diagnosis (n = 364) other than sepsis.

Results

Significant group differences were found on all physiologic monitoring variables tested (high temperature, P = 0.000; low temperature, P = 0.001; heart rate, P = 0.004; respiratory rate, P = 0.005; and mean arterial pressure, P = 0.000). In the logistic regression model, high temperature and mean arterial pressure functioned as significant predictors, with odds ratios of 2.12 for temperature at or above 38°C and 3.87 for MAP less than 70 mmHg. The odds ratio of having sepsis was 4.63 if both of these predictors were present.

Conclusion

It is important to understand the value of common monitoring parameters in the early identification of sepsis, since those parameters are continuously monitored and readily available. It is the responsibility of bedside clinicians to assure that the parameters chosen for monitoring provide the most accurate reflection of the patient's clinical status. These results provide some support for the use of the currently recommended criteria for physiologic monitoring in the early identification of patients at risk for developing sepsis. Furthermore, if this could be done automatically, it would probably shorten the recognition time and thus speed up the initiation of sepsis treatment. ProtocolWatch is a tool that offers an electronic version of the SSC guidelines, screens the physiologic criteria automatically, and is resident on a bedside patient monitor. Development of tools such as ProtocolWatch will probably be an important adjunct to sepsis identification and treatment in the future.