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CE Article

Physiological Monitoring for Critically Ill Patients: Testing a Predictive Model for the Early Detection of Sepsis

Corresponding author: Karen K. Giuliano, RN, PhD, 3000 Minuteman Rd, MS 500, Andover, MA 01810 (e-mail: Karen.Giuliano{at}philips.com).

• Objective To assess the predictive value for the early detection of sepsis of the physiological monitoring parameters currently recommended by the Surviving Sepsis Campaign.

• Methods The Project IMPACT data set was used to assess whether the physiological parameters of heart rate, mean arterial pressure, body temperature, and respiratory rate can be used to distinguish between critically ill adult patients with and without sepsis in the first 24 hours of admission to an intensive care unit.

• Results All predictor variables used in the analyses differed significantly between patients with sepsis and patients without sepsis. However, only 2 of the predictor variables, mean arterial pressure and high temperature, were independently associated with sepsis. In addition, the temperature mean for hypothermia was significantly lower in patients without sepsis. The odds ratio for having sepsis was 2.126 for patients with a temperature of 38°C or higher, 3.874 for patients with a mean arterial blood pressure of less than 70 mm Hg, and 4.63 times greater for patients who had both of these conditions.

• Conclusions The results support the use of some of the guidelines of the Surviving Sepsis Campaign. However, the lowest mean temperature was significantly less for patients without sepsis than for patients with sepsis, a finding that calls into question the clinical usefulness of using hypothermia as an early predictor of sepsis. Alone the group of variables used is not sufficient for discriminating between critically ill patients with and without sepsis.

Notice to CE enrollees: A closed-book, multiple-choice examination following this article tests your understanding of the following objectives: Describe the 4 criteria of which at least 2 are needed to meet the definition of systemic inflammatory response syndrome. Identify the difference between severe sepsis and septic shock. Describe the 2 independent and significant study variables that are associated with sepsis in the first 24 hours of admission to the intensive care unit. To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue."

This article has been cited by other articles:

				R. Sincic and K. K. Giuliano Reader Affirms Association Between Hypothermia and Sepsis Am. J. Crit. Care., July 1, 2007; 16(4): 332 - 333. [Full Text] [PDF]