Sepsis: Symptoms, Assessment, Diagnosis, and the Hour-1 Bundle in Patients With Cancer

CE: Febrile Neutropenia in the Chemotherapy Patient

“…11 Special attention must be given to patients who present or develop abnormal vital signs, as this may indicate not just an infection but sepsis, which is associated with a higher incidence of hospital stays and mortality in the oncology population. 19 Early warning scoring (EWS) tools or sepsis screenings have been implemented in various settings to improve sepsis treatment and management. 20 Using clinical parameters such as temperature, heart rate, respiratory rate, systolic blood pressure, and central nervous system assessment, EWS tools (whether automated or handwritten) can help nurses with their assessments and identify patients with sepsis; in conjunction with early involvement of the ICU team, the mortality rate can be improved.…”

“…In 2002, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine initiated the Surviving Sepsis Campaign (SSC), which issued clinical guidelines to improve the quality of sepsis care. 19 According to the SSC guidelines, patients with neutropenia don't need to be treated differently from nonneutropenic patients. 20 Recent updates to the guidelines emphasize five goals of care to be accomplished in the first hour of treatment: lactate level measurement; blood culture results; broad-spectrum antibiotic administration; rapid fluid resuscitation; and the addition of vasopressors to maintain a mean arterial pressure (MAP) greater than or equal to 65 mmHg (see The First Hour of Sepsis 21 ).…”

“…19 If the patient is hypotensive or has a lactate level of 4 mmol/L or greater, 30 mL/kg of crystalloid fluid should be administered to improve blood pressure and clear the lactate. 19,21 Balanced crystalloid solutions that have an electrolyte composition closer to plasma, are preferred over normal saline, which can cause hyperchloremic metabolic acidosis and acute kidney injury. 22 If blood pressure is unresponsive to fluid, then vasopressors should be initiated to perfuse organs and tissues.…”

“…Balanced crystalloid solutions that have an electrolyte composition closer to plasma, are preferred over normal saline, which can cause hyperchloremic metabolic acidosis and acute kidney injury 22. If blood pressure is unresponsive to fluid, then vasopressors should be initiated to perfuse organs and tissues 19. A MAP or an average arterial pressure throughout the cardiac cycle (systole and diastole) of at least 60 mmHg is required to perfuse vital organs, including the brain, kidneys, and liver 23.…”

Impact of Sepsis Identification and Treatment Time on In-Hospital Mortality, Length of Stay, and Hours in the Intensive Care Unit

“…1,3 The Surviving Sepsis Campaign (survivingsepsis.org) has provided guidance on implementation of 6-hour, 3-hour, and finally 1-hour bundles for sepsis care, and there is evidence that implementation of these guidelines has improved timeliness of sepsis treatment and outcomes for people with sepsis around the world. 4-25 The Center for Medicare and Medicaid Services (CMS) in the US has also established a quality measure for hospitals based on compliance with a sepsis treatment bundle (SEP-1), although the bundle has received criticism, and there does not appear to be evidence that its implementation resulted in improved outcomes for people with sepsis. 26-33…”