Sepsis Management & SOFA Scoring

Comprehensive sepsis protocols and assessment tools

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Sepsis Management Protocol

SOFA Scoring, Bundle Compliance, and Treatment Guidelines

⚠️ TIME IS CRITICAL ⚠️

Every hour of delay in antibiotic administration increases mortality by 7.6%

Sepsis Definitions

Sepsis-3 Definition

Sepsis: Life-threatening organ dysfunction caused by a dysregulated host response to infection.

  • SOFA score ≥2 points
  • Evidence of infection
  • Organ dysfunction

Septic Shock

Septic Shock: Sepsis with circulatory, cellular, and metabolic abnormalities.

  • Vasopressor requirement
  • Lactate >2 mmol/L
  • Persistent hypotension

Quick SOFA (qSOFA)

≥2 of the following:

Respiratory Rate: ≥22/min
Altered Mental Status: GCS <15
Systolic BP: ≤100 mmHg

SOFA (Sequential Organ Failure Assessment) Score

The SOFA score assesses organ dysfunction in six organ systems. Each system is scored from 0-4, with higher scores indicating worse organ function.

1

Respiratory System (PaO₂/FiO₂)

0: ≥400
1: <400
2: <300
3: <200 with respiratory support
4: <100 with respiratory support
2

Coagulation (Platelets ×10³/μL)

0: ≥150
1: <150
2: <100
3: <50
4: <20
3

Liver (Bilirubin mg/dL)

0: <1.2
1: 1.2-1.9
2: 2.0-5.9
3: 6.0-11.9
4: ≥12.0
4

Cardiovascular (MAP or Vasopressors)

0: MAP ≥70
1: MAP <70
2: Dopamine ≤5 or Dobutamine
3: Dopamine >5 or NE ≤0.1
4: Dopamine >15 or NE >0.1
5

Central Nervous System (Glasgow Coma Scale)

0: 15
1: 13-14
2: 10-12
3: 6-9
4: <6
6

Renal (Creatinine mg/dL or Urine Output)

0: <1.2
1: 1.2-1.9
2: 2.0-3.4
3: 3.5-4.9
4: ≥5.0

SOFA Score Interpretation

0-6: Low mortality risk (≤10%)
7-9: Moderate mortality risk (15-20%)
10-12: High mortality risk (40-50%)
13-24: Very high mortality risk (≥80%)

Sepsis Bundle (1-Hour Bundle)

The 1-hour bundle should be initiated immediately for patients with suspected sepsis or septic shock.

1

Lactate Measurement

Measure lactate level. Re-measure if initial lactate >2 mmol/L.

2

Blood Cultures

Obtain blood cultures before administering antibiotics.

3

Broad-Spectrum Antibiotics

Administer broad-spectrum antibiotics within 1 hour.

4

Fluid Resuscitation

Begin rapid administration of 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

5

Vasopressors

Apply vasopressors if patient is hypotensive during or after fluid resuscitation.

Bundle Compliance Monitoring

Target: Complete bundle within 1 hour
Measurement: Time from recognition to completion
Goal: ≥80% compliance rate
Documentation: Bundle completion checklist
Audit: Monthly bundle compliance review
Feedback: Real-time alerts for incomplete bundles

Antibiotic Therapy

Timing is Critical

Goal: Administer within 1 hour of recognition
Delay Impact: 7.6% mortality increase per hour
Monitoring: Track time from recognition to administration
Route: IV administration preferred
Dosing: Weight-based dosing for obese patients
Adjustment: Renal/hepatic function consideration

Broad-Spectrum Coverage

Community-Acquired

  • Piperacillin-tazobactam
  • Ceftriaxone + metronidazole
  • Meropenem
  • Vancomycin (if MRSA suspected)

Healthcare-Associated

  • Meropenem
  • Piperacillin-tazobactam
  • Cefepime
  • Vancomycin + coverage for resistant organisms

Culture-Directed Therapy

De-escalation: Narrow spectrum based on cultures
Duration: 7-10 days for most infections
Monitoring: Clinical response and biomarkers
Source Control: Remove infected devices
Drainage: Abscess drainage if present
Follow-up: Monitor for complications

Fluid Resuscitation

Initial Fluid Bolus

  • Volume: 30 mL/kg crystalloid
  • Timing: Within 3 hours
  • Type: Balanced crystalloid preferred
  • Monitoring: Clinical response

Response Assessment

  • Blood pressure improvement
  • Heart rate normalization
  • Capillary refill time
  • Lactate clearance

Vasopressor Therapy

Norepinephrine:
• First-line vasopressor
• Target MAP ≥65 mmHg
• Start: 0.05-0.1 μg/kg/min
Vasopressin:
• Second-line agent
• Fixed dose: 0.03 U/min
• Add to norepinephrine
Dopamine:
• Alternative to norepinephrine
• Use in bradycardia
• Higher arrhythmia risk

Monitoring & Supportive Care

Hemodynamic Monitoring

  • Continuous blood pressure monitoring
  • Central venous pressure (CVP)
  • Central venous oxygen saturation (ScvO₂)
  • Cardiac output monitoring
  • Lactate clearance

Organ Support

  • Mechanical ventilation if needed
  • Renal replacement therapy
  • Glucose control (140-180 mg/dL)
  • DVT prophylaxis
  • Stress ulcer prophylaxis

Quality Metrics

Bundle Compliance:
• 1-hour bundle completion
• 3-hour bundle completion
• 6-hour bundle completion
Time Metrics:
• Time to antibiotics
• Time to fluid bolus
• Time to vasopressors
Outcome Metrics:
• 28-day mortality
• ICU length of stay
• Hospital length of stay