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.[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][47] 

  • 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.

Re-calculate the NEWS2 score and re-evaluate risk of sepsis periodically:[3][45]

  • Every 30 minutes, for those at high risk of severe illness or death from sepsis

  • Every hour, for those at moderate risk of severe illness or death from sepsis

  • Every 4 to 6 hours, for those at low risk of severe illness or death from sepsis

  • When standard observations are carried out, in line with local protocol, for those at very low risk of severe illness or death from sepsis.

Ensure a senior clinical decision-maker (e.g., ST3 level doctor in the UK) attends in person within 1 hour of any intervention if there is no improvement in the patient’s condition. Refer to or discuss with a critical care consultant or team.[3]​ Inform the responsible consultant.[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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