How should a patient with sepsis or septic shock be monitored in the ICU?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

A patient with sepsis who is admitted to the ICU should be monitored carefully to facilitate prevention and treatment of the infectious complications that may perpetuate SIRS or trigger recurrent sepsis after the initial improvement. Such complications include sinusitis, urinary tract infection, urosepsis, intravascular catheter–related infections, acalculous cholecystitis, and translocation of bacteria or endotoxin from the gut. Several of these ailments may not manifest clinically; accordingly, a high index of suspicion is crucial for early diagnosis and treatment.

Important to note, three large prospective multicenter randomized clinical trials of EGDT in the management of septic shock (ProCESS [Protocolized Care for Early Septic Shock], [57] ARISE [Australasian Resuscitation In Sepsis Evaluation], [58] and ProMISe [Protocolised Management In Sepsis] [59] ) have all yielded the same negative results, namely that the use of strict protocolized monitoring (central venous catheterization, lactate and ScvO2 measures) and management (targeting a hemoglobin >8 g/dL, ScvO2 >70%) were no better than usual care as long as patients were managed closely.


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