Remeasure Lactate If Initial Lactate Was Elevated Goal

Definition

The mortality rate is high in septic patients with both hypotension and lactate ≥4 mmol/L, and is also increased in severely septic patients with hypotension alone and lactate ≥4 mmol/L. If central venous oxygen saturation (ScvO2)  is not available, lactate normalization may be a feasible option in the patient with severe sepsis-induced tissue hypoperfusion. ScvO2 and lactate normalization may also be used as a combined end point when both are available.

 

Compliance with this element in the Severe Sepsis Bundles (as part of the 6-Hour Septic Shock Bundle) is defined as the percent of patients following septic shock or lactate ≥4 mmol/L (36 mg/dl) identification for whom the lactate was repeated during the first 6 hours after presentation.

 

Numerator: The number of patients who had repeat lactates collected during the first 6 hours following presentation with severe sepsis with lactate ≥4 mmol/L (36 mg/dl) and septic shock

 

Denominator: The total number of patients with severe sepsis with lactate ≥4 mmol/L (36 mg/dl) and septic shock

 

Exclusion: Severe sepsis with lactate <4 mmol/L and non-severe sepsis

 

Goal

Increase central venous oxygen saturation to >70 percent within 6 hours in 100 percent of indicated cases.

 

Data Collection Plan

Data may be collected concurrently — that is, once a patient is placed on the hospital’s severe sepsis protocol, data can be abstracted from the patient chart in real time — or retrospectively using a chart review, a method generally recommended for more experienced improvement teams.

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