Monitoring

Ensure frequent and ongoing monitoring.[3]

  • Standard monitoring of vital signs, pulse oximetry, level of consciousness, and urinary output is important for any patient with suspected sepsis.

  • The National Institute for Health and Care Excellence (NICE) in the UK recommends continuous or half-hourly monitoring (depending on setting) for any patient considered to be at high risk of deterioration (defined in the NICE guideline as meeting one or more of its high-risk criteria for severe illness or death from sepsis).[3]

Use a track-and-trigger scoring system such as the National Early Warning Score 2 (NEWS2) to identify any signs of deterioration.[3] Your monitoring should include: 

  • Vital signs: heart rate, blood pressure, oxygen saturations, respiratory rate, and temperature

    • Measure blood pressure via an arterial line if the patient does not respond to initial treatment or needs vasoactive drugs. It provides precise, continuous monitoring, and access for arterial blood sampling

  • Hourly urine output[3][43][46] 

  • Lactate

    • The lactate level should decrease if the patient is clinically improving

    • Frequency of repeat lactate measurement depends on the cause of sepsis and treatment given.

In the UK, use physiological track-and-trigger systems to monitor all adult patients in acute hospital settings.[3]

Consider using a validated scale such as the Glasgow Coma Scale or AVPU ('Alert, responds to Voice, responds to Pain, Unresponsive') scale to monitor the mental state of a patient with suspected sepsis.[3]

  • AVPU should raise concerns if the assessment shows the patient is anything other than 'alert'.

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