Early proactive diagnosis and treatment algorithm for sepsis from the perspective of the Royal College of General Practitioners and the Surviving Sepsis Campaign (2021)

Abstract

This paper presents a diagnosis of the likely risk of sepsis using the National Early Warning Score (NEWS2). Accor­ding to the UK National Health Service and the Royal College of General Practitioners, sepsis should be suspected and immediate intensive care should be considered if a patient has NEWS2 score of 5 or more, or if the patient has NEWS2 score of 3 or more: non-blanching rash, mottled/ashen/cyanotic skin; responds only to voice/pain or does not respond; no urination in the last 18 hours or diuresis less than 0.5 ml/kg on catheterization; serum lactate more than 2 mmol/l. The measures to be taken within the first hour of a diagnosis of the likely risk of sepsis are outlined, as well as criteria for the lack of their effectiveness; the main goals of intensive care in sepsis: identification and control of foci of infection; antibiotic therapy, fluid resuscitation, additional oxygen supply; recommended parameters for continuous or half-hour monitoring of patients with sepsis who are at high risk of deterioration; blocks of intensive care, which should be initiated only by specialists experienced in sepsis management. The indicators of hospital lethality depending on the level of blood serum lactate are given: less than 2 mmol/l — 15 %, from 2.1 to 3.9 mmol/l — 25 %, more than 4 mmol/l — 38 %. The presented algorithm is fully consistent with the Surviving Sepsis Campaign guidelines (2021).

Keywords

• sepsis
• proactive diagnosis
• intensive care
• algorithm