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Patient Particulars

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ComorbidityDefinition
Cardiovascular diseaseIschaemic heart disease (IHD), heart failure
Chronic lung diseaseChronic obstructive pulmonary disease (COPD), asthma, bronchiectasis, post-tuberculosis related lung disease, interstitial lung disease (ILD), excluding primary or secondary lung malignancy. Patients who are undergoing treatment for tuberculosis or non-tuberculosis mycobacterium (NTM) prior to ICU admission should be included in this category
Chronic neurological diseaseStrokes, neuromuscular disease, epilepsy, movement disorders, excluding brain tumors
Chronic kidney diseaseKidney damage > 3 months (abnormal blood/urine composition or radiological renal abnormalities or glomerular filtration rate < 60mL/min/1.73m2), excluding renal cell carcinoma
Peptic ulcer diseaseGastric and duodenal ulcers
Chronic liver diseaseProlonged course of hepatic disease > 6 months, excluding hepatocellular cancer
Diabetes mellitusAny type of diabetes mellitus
Human immunodeficiency virus (HIV) infectionPositive HIV serology with or without acquired immunodeficiency syndrome (AIDS)-defining illness
Connective tissue diseasePresence of appropriate clinical symptoms and high titres of specific autoantibodies that fulfill the criteria of different connective tissue diseases. Examples include systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), gout, systemic sclerosis, scleroderma
ImmunosuppressionPatients on long term steroids or other immunosuppressants (excluding patients with haematological conditions or other malignancies)
Haematological malignanciesInclude leukaemia, lymphoma, multiple myeloma
Solid malignant tumoursSuch as breast, colon, lung, prostate, skin, etc (excluding haematological malignancies)
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Vital signs (upon admission to ICU)

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FiO2 is to be written in decimals. 100% = 1.0, 50% = 0.5, 10% = 0.1, etc
Refer to the chart below for your FiO2 score

  

Oxygen tank flow rate in liters/min

FiO2

Nasal cannula

0 L/min

0.21

1 L/min

0.24

2 L/min

0.28

3 L/min

0.32

4 L/min

0.36

5 L/min

0.40

6 L/min

0.44

Face mask

5 L/min

0.4

6 L/min

0.5

7-8 L/min

0.6

Nasopharyngeal catheter

4 L/min

0.4

5 L/min

0.5

6 L/min

0.6

Venturi mask

FiO2 as set on the apparatus

Face mask with reservoir

6 L/min

0.6

7 L/min

0.7

8 L/min

0.8

9 L/min

0.9

10 L/min

0.95

15 L/min (non-rebreather mask)

1.0

High flow nasal cannula, non-invasive ventilation, mechanical ventilation

Regardless of inspiratory flow, positive end-expiratory pressure (PEEP)

FiO2 as set on the apparatus

Severity of illness scores

Please calculate your scores and enter them in the fields below. Calculators are provided if necessary.

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SIRS Calculator
Please enter result as a score. 1 point per each matching criteria.

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Site of infection

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Select all that apply

Definition of infections

Pneumonia requires the presence of radiographic infiltrates and features including fever or hypothermia, leukocytosis or leukopenia and purulent respiratory secretions.

Intra-abdominal infections include but are not limited to intra-abdominal abscesses, peritonitis, biliary tract infections, pancreatic infections, enteritis, and colitis.

Urinary tract infection requires typical features of fever, urgency, frequency, dysuria, pyuria and haematuria, together with confirmatory radiological features and/or positive culture results.

Soft tissue and skin infections include surgical site infections, septic arthritis, cellulitis and necrotizing fasciitis.

Catheter-related blood stream infection is defined as bacteremia with an intravascular device in situ and no other apparent source for the bloodstream infection, with culture results.

Systemic infections refer to infections without a clear primary site of infection, as is often the case in infections such as dengue and malaria.

Positive cultures

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Select all that apply

MediumDefinition of positive culture result
Blood
  • Microorganism cultured
  • Common skin contaminants like coagulase-negative staphylococci, Bacillus species, Corynebacterium, species, micrococci and Propionibacterium species are disregarded unless they are deemed significant by the managing physician or cultured from > 2 blood cultures
  • Primary bacteraemia is diagnosed if the microorganism cultured is not related to any infected site
  • For catheter-related bloodstream infection, paired blood cultures must yield microbiological diagnosis
    • Catheter blood culture yielding 5-fold higher yield than peripheral blood culture
    • Catheter blood cultures positive > 2 hours earlier than peripheral blood culture
Sputum, blind endotracheal aspirates, bronchoalveolar lavage (BAL)
  • Microorganism cultured
  • Moderate to heavy growths of bacteria with few epithelial cells seen on gram stain examination (< 10 per high power field)
  • Candida is often a contaminant in immunocompetent patients. Do not record candida as the aetiology of pneumonia unless the managing physician determines otherwise
Pleural fluid
  • Microorganism cultured
  • Pus
Urine
  • Isolation of 105 colony forming units (cfu)/mL of microorganisms (or 103 cfu/mL in catheterized patients)
Stool
  • Microorganism cultured
Bile, peritoneal fluid
  • Microorganism cultured
Liver abscess fluid
  • Microorganism cultured
Non-liver abscess fluid
  • Microorganism cultured
Cerebrospinal fluid
  • Microorganism cultured
Synovial fluid
  • Microorganism cultured
Soft tissue, wound and skin cultures, surgical site cultures
  • Microorganism cultured
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Select all that apply

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Measurements at time zero

Time Zero

Time zero is the onset of sepsis. This is determined according to the patient’s location within the hospital when sepsis is diagnosed:
        i. For patients presenting to the emergency department with sepsis, time zero is defined as the time of triage.
        ii. For patients who develop sepsis in the wards or other non-emergency department units, time zero is determined by searching the clinical documentation for the time of diagnosis of sepsis. This may include, for example, a physician’s note or timed and dated orders, a timed and dated note of a nurse’s discussion of sepsis with a physician, or timed records initiating referral to the ICU for sepsis.
        iii. If no time and date can be found by searching the chart, the default time of presentation is the time of admission to the ICU.
        iv. In the rare event that the patient does not present with sepsis in the emergency department, but deteriorates and develops sepsis in the emergency department while being observed or while waiting for a hospital bed, time zero is determined by searching the clinical documentation for the time of diagnosis of sepsis. This may include, for example, a physician’s note or timed and dated orders, a timed and dated note of a nurse’s discussion of sepsis with a physician, or timed records initiating referral to the ICU for sepsis.

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Resources used in ICU (anytime in the current ICU stay)

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Limitation of life-sustaining treatments (Anytime during ICU stay)

Select all that apply

Outcome & Discharge

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