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Quick Tip for Families in Intensive Care: How to Properly Monitor for Sepsis, Including Continuous Blood Pressure Monitoring & Timely Labs in ICU

“How to properly monitor for sepsis, including using continuous blood pressure monitoring and timely labs in intensive care?” This is a question that one of our clients has asked that I’m going to answer today.

My name is Patrik Hutzel from intensivecarehotline.com and this is another quick tip for families in intensive care.

So, one of our clients asked us to do a medical record review

for one of their family members in intensive care and one of the questions that the client had was, “How to properly monitor for sepsis, including using continuous blood pressure monitoring and timely labs in intensive care?” So, let’s look at the question in broader terms before we go to the individual situation for the client.

So, monitoring for sepsis in ICU is absolutely critical for early detection and intervention and I’m going to look at a comprehensive approach to properly monitor for sepsis with a focus on continuous blood pressure monitoring and timely laboratory assessment.

Number one, clinical monitoring.

Vital signs (continuous or frequent monitoring): Blood pressure, use arterial lines for continuous blood pressure monitoring, especially when patients are unstable. Next, heart rate. Tachycardia can indicate early sepsis or worsening condition. Tachycardia means a high heart rate, usually above 100 beats per minute. Respiratory rate elevation can precede other signs of sepsis. Respiratory rate means breaths per minute. Temperature, look for fever or hypothermia. Oxygen saturation, continuous pulse oximetry. Level of consciousness, changes may reflect worsening perfusion or encephalopathy.

Next, hemodynamic monitoring.

Arterial line provides real-time blood pressure readings and allows for easy access to get arterial blood gas draws. Arterial line is also critical for titrating vasopressors and inotropes and whilst I haven’t spoken about vasopressors or inotropes, they are often used in patients that are septic because they often go into septic shock. They dropped their blood pressure to very low levels that could cause organ damage or are even incompatible with life. Then in order to get the blood pressure up, you need to use inotropes or vasopressors to get the blood pressure back up to levels that are compatible with life and that are compatible with sufficient organ perfusion.

Next, central venous catheter can monitor central venous pressure, also known as CVP to ascertain the fluid status of a patient for fluid status assessment and delivery of vasopressors as well.

Next, SVO2 (Central venous oxygen saturation monitoring) is also possible with Swan-Ganz or PA catheters, and that is also important to ascertain whether there is a sepsis or a septic shock or not.

Next, laboratory or pathology monitoring.

What is important here is that it’s timely and repeated. Initial labs within an hour of sepsis suspicion. Lactate, the marker of tissue hypoperfusion. Repeat in 2 to 4 hours if greater than 2 millimoles per liter. Blood cultures, 2 sets before starting antibiotics, but don’t delay treatment. Complete or full blood count, FBC (Full Blood Count) or CBC (Complete Blood Count), look for leukocytosis, leukopenia, thrombocytopenia. CMP (Comprehensive Metabolic Panel), monitor organ function like kidney or liver. CRP (C-reactive Protein) or procalcitonin, inflammatory markers used to assess severity or guide antibiotic therapy. Coagulation profiles such as PT (Prothrombin Time), INR (International Normalized Ratio), aPTT (activated Partial Thromboplastin Time), D-dimer for DIC (Disseminated Intravascular Coagulation) screening. Ongoing repeat labs every 4 to 6 hours initially or as clinically indicated. Repeat lactate, CBC, BMP (Basic Metabolic Panel), ABG (Arterial Blood Gas), and cultures if new infection signs appear.

So, then you need to look at additional monitoring tools such as urine output via Foley catheter. Less than 0.5 mL per kg per hour indicates possible renal hypoperfusion. Next, daily weight fluid balance, assess for capillary leak, fluid overload, or under resuscitation. Next, chest X-ray and imaging, if pneumonia or other sources for infection are suspected.

Next, early warning scores optional but helpful. Early warning scores are breathing rate of more than 22 per minute, altered mentation, and systolic blood pressure at less than 100 millimeter per mercury. Also, comprehensive score includes PaO2 (Partial pressure of oxygen), which is oxygen saturation, FiO2 (fraction of inspired oxygen) especially when patients are ventilated, platelet count, bilirubin, mean arterial blood pressure, Glasgow Coma Scale, and creatinine.

Next, sepsis bundle, such as surviving sepsis campaign one hour bundle, should be protocolized. Rapid communication between bedside nurses, respiratory therapists, labs, and physicians is vital.

Summary of key interventions.

Blood pressure arterial line for real-time accurate mean arterial blood pressure tracking, heart rate and rhythm, continuous ECG (electrocardiogram) monitoring, labs, timely lactate cultures, full blood count, CMP (Comprehensive Metabolic Panel),  coagulation profile, oxygenation and arterial blood gasses , pulse oximetry, arterial blood gasses as needed, fluid status and output, Foley catheter, CBP (Central Blood Pressure) monitoring, central venous pressure monitoring, daily weights, neurological status, regular Glasgow Coma Scale checks, and sedation holds if needed.

So, what did all of that look like in our client’s case? The client was admitted to hospital and was diagnosed initially with multiple drug-resistant infections, including enterobacteria, Vancomycin resistant enterococcus, and MRSA (Methicillin-Resistant Staphylococcus Aureus). So, considerable amounts of antibiotics the client received throughout hospitalization.

Upon arrival to the hospital, the client became ventilator -dependent pretty quickly, unresponsive, severely malnourished, and had multiple open wounds with exposed bones, placing the client at continued high risk for infection, sepsis, and hemodynamic instability. So, that is exactly what put this client at very, very high risk of sepsis and septic shock right away.

Whilst they’ve done all the blood tests, it turned out that there was no documentation of mean arterial blood pressure or MAP trending, which is a critical component in sepsis management in ICU level care because the mean arterial blood pressure is used to determine organ perfusion status and helps guide decisions regarding the initiation of vasopressors and inotropes.

Like I explained earlier, if blood pressure is too low, organ perfusion may suffer and therefore patients may go into organ failure. ICU protocols, generally speaking, recommend maintaining a mean arterial blood pressure greater than 65 millimeter per mercury in septic patients because if it’s less than 65 millimeter per mercury, there may not be enough organ perfusion.

Before vasopressors are used for systolic blood pressure less than 100-millimeter mercury, fluid resuscitation should be used. If that fails, then obviously, vasopressors or inotropes might be used, or if hemoglobin is low or albumin is low, then maybe a plasma expander such as albumin or even red blood cells might be used to get blood pressure up. So, it all depends on the situation.

In any case, I hope that helps you understand how sepsis should be managed in intensive care.

Now, I have worked in critical care nursing for 25 years in 3 different countries where I worked as a nurse manager for over 5 years in intensive care and I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently, very confidently say that we have saved many lives for our clients in intensive care. You can verify that on our testimonial section and you can verify it on our intensivecarehotline.com podcast section both at intensivecarehotline.com.

Like I always say, our advice is life changing because we have saved so many lives with our consulting and advocacy. You can join a growing number of members and clients that we have helped over the years to improve their lives instantly, make informed decisions, have peace of mind, control, power, and influence, making sure the loved ones get the best care and treatment, always.

That’s why I do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. I also talk to doctors and nurses directly with you or on your behalf, or I’ll set you up with the right questions to ask, depending on your unique situation. When I talk to doctors and nurses directly, I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care. I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 e-books and 21 videos that I’ve personally written and recorded. All of that will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment, always.

All of that, you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

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Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.