Learning Objective #1: Briefly discuss the pathophysiology of sepsis

Learning Objective #2: Discuss current initiatives for improving the care of critically ill patients with sepsis

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The purpose of this research was to develop a predictive model for the early identification of sepsis using the currently recommended physiologic parameters that are continuously or frequently monitored in the critical care setting. Data from the Project IMPACT ® international dataset were used to assess whether a combination of the physiologic parameters of heart rate, mean arterial blood pressure, body temperature and respiratory rate could distinguish between critically ill adult patients with a diagnosis of sepsis and those without a diagnosis of sepsis in the first 24 hours of intensive care unit admission. All four predictor variables used in the analyses (respiratory rate, heart rate, mean arterial blood pressure, and temperature) differed significantly between the septic and nonseptic patient groups. However, using logistic regression, only two out of the four predictor variables (mean arterial blood pressure and temperature) were independently associated with being septic. According to Hosmer and Lemeshow goodness-of-fit tests, the logistic regression model was a good fit and explained between 10.2% and 13.6% of the variance. Using the significant predictors of temperature and mean arterial blood pressure, the odds ratio for having sepsis was 2.126 for patients with a temperature of 38OC or higher and only .258 for patients with a mean arterial blood pressure of less than 70mmHg. However, the odds of having sepsis were 3.5 times greater if the patient had both of these physiologic conditions present. The results of this research provide some support for the use of some of the currently recommended clinical monitoring guidelines for patients with sepsis, since there were significant differences between septic and non-septic patients in all four of the proposed physiologic predictor variables. However, the results also underscore that more work needs to be done to refine these variables for better discrimination between septic and non-septic patients.