1. Respiratory Therapists & Sepsis: How we can work together
Matthew Dartt RRT-ACCS
Mackenzie R. Roesti, RN, MSN, CCRN

2. What is Sepsis?
Sepsis is a complex illness involving both infection and inflammation.
Normally, the body’s response to an infection is targeted to the site of the infection. With sepsis, the body’s response, instead of being localized to the site of infection, causes symptoms to occur throughout the body
Sepsis Continuum:
SIRS- Systemic Inflammatory Response Syndrome
Sepsis – Infection PLUS systemic inflammation (SIRS) in response to infection.
Severe Sepsis – Sepsis complicated by organ dysfunction, hypo-perfusion or hypotension (e.g. altered mental status, oliguria, lactic acidosis)
Septic Shock –Severe sepsis complicated by persistent arterial hypotension unexplained by other causes, despite adequate fluid resuscitation.

3. Sepsis: A Disease Defining Continuum
2 SIRS criteria plus (+) confirmed or suspected infection
Severe Sepsis
Sepsis plus (+) 1 NEW onset organ dysfunction/failure
Septic Shock
Severe Sepsis plus (+) Hypotension despite fluid resuscitation of 30mL/kg,
&/or
Serum lactate levels  36mg/dL (4 mmol/L), and perfusion abnormality

4. Sepsis Pathophysiology

5. Acute Organ Dysfunction in Sepsis

6. Respiratory Warning Signs of Sepsis
Within the past 12 hours…
Increased tachypnea (RR >20)
Increased WOB/diaphoresis
Patient oxygen requirements increasing to maintain their current status
New High Flow Nasal Cannula
Increase in PEEP on mechanical ventilator
New BiPap/CPAP
(not chronic/at home use at night)
Intubation
These organ dysfunctions can make an RN’s sepsis screen POSITIVE!

7. Respiratory Therapists’ Role
There are approximately 1.5 million cases of sepsis every year in the United States with a mortality rate up to 50%.
Sepsis Statistics
More than 1.5 million people get sepsis each year in the U.S
About 250,000 Americans die from sepsis each year
One in three patients who die in a hospital have sepsis
Lung infection such as pneumonia (35%)
Centers for Disease Control and Infection 2017

8. Respiratory Therapists’ Role
Currently Nursing screens patients for Sepsis once a shift, if there is an acute change or if the patient is transferred.
Respiratory Therapist can fill the gap:
We have patients we see frequently on med surge floors as frequent as every 3 hours.
RT’s can play a critical role in filling the sepsis assessment gap and bring the attention needed to the patients who screen positive
Centers for Disease Control and Infection 2017

10. Respiratory Therapists’ Role
IDENTIFY
SIRS Criteria:
T >38.3 degrees C (101 degrees F) OR <36 degrees C (96.8 degrees F)
HR >90
RR >20
WBC >12,000 OR <4,000 OR >10% Bands
COMMUNICATE
Notify the patient’s nurse and charge nurse
Notify them there patient has screened for two signs of SIRS
If you have any questions contact your hospital Sepsis RNs – Pager 95611

11. Respiratory Therapists’ Role
Notify primary RN
Notify charge RN
Document notification in flowsheets
“RN (insert RN name here) notified”
The Sepsis Screen is under assessment in Flowsheets
You can chart on patient vital signs
HR > 90, RR > 20
If you have any questions contact your hospital Sepsis RNs – Pager 95611

12. Respiratory Therapists’ Role
Under Assessment in the flowsheet
EXAMPLES of organ system dysfunction or failure (Organ Dysfunction r/t chronic disease or medication does not apply)
Cardiovascular: Systolic BP < 90 OR MAP <65 OR decrease by > 40mmHg from baseline for patient = (+)Septic Shock
Respiratory: New need for mechanical ventilation or BiPAP or Highflow Nasal Cannula
Renal: Creatinine > 2.0 OR urine output < 0.5mL/kg/hr for 2 hours
Hematologic: Platelets < 100,000 OR INR > 1.5 (not on Warfarin) OR aPTT > 60 sec
Hepatic: Bilirubin > 2.0
Metabolic: Lactate > 18 mg/dL = (*)Severe Sepsis                          Lactate greater than or equal to 36 =
If you have any questions contact your hospital Sepsis RNs – Pager 95611

13. Respiratory Therapists’ Role
Respiratory has a tremendous opportunity to assist in the sepsis screen
We are a critical part of the team and help catch treat sepsis early
Early goal-directed therapy completed within the first six hours of sepsis recognition significantly decreases in-hospital mortality. Initial management includes respiratory stabilization followed by aggressive fluid resuscitation.  GAUER, R. (2013)

14. References
Centers for Disease Control and Infection (2017). Sepsis: Data & Reports. CDC. Retrieved from:
GAUER, R. (2013). Early Recognition and Management of Sepsis in Adults: The First Six Hours. Am Fam Physician. 88(1):44-53.Retreived from