Digital Capillary Refill for Monitoring of Sepsis

This is an observational studying assessing changes in capillary refill time over the course of sepsis treatment.

Inclusion criteria

• Clinical evidence of a known or suspected infection and orders written for administration of IV antibiotics
• Hypotension as defined by the need for any vasopressor (and 1 liter of fluid already administered) OR respiratory failure defined by assisted ventilation (includes mechanical ventilation and BIPAP), CPAP, or greater than or equal to 6 liters/minute of supplemental oxygen

Exclusion criteria

• No consent/inability to obtain consent from the participant or a legally authorized representative
• Diagnosis of cirrhosis by medical chart review
• Liver transplant recipient
• AST or ALT greater than five times upper limit of normal
• Diagnosis of ongoing chronic alcohol use disorder/abuse by chart review; if medical record unclear, use Appendix F
• Clinical diagnosis of diabetic ketoacidosis or other condition such as profound hypoglycemia that requires hourly blood glucose monitoring
• Hypersensitivity to Acetaminophen or Vitamin C
• Patient, surrogate or physician not committed to full support (Exception: a patient will not be excluded if he/she would receive all supportive care except for attempts at resuscitation from cardiac arrest)
• Home assisted ventilation (via tracheotomy or noninvasive) except for CPAP/BIPAP used only for sleep-disordered breathing
• Current active kidney stone
• Known history of oxalate kidney stones or history of oxalate nephropathy
• Kidney transplant recipient
• Use of home oxygen for chronic cardiopulmonary disease
• Moribund patient not expected to survive 24 hours
• Underlying malignancy or other condition with estimated life expectancy of less than 1 month
• Pregnant woman, woman of childbearing potential without a documented negative urine or serum pregnancy test during the current hospitalization, or woman who is breast feeding
• Prisoner
• Enrollment in another critical care based pharmacologic interventional trial
• Treating team unwilling to enroll because of intended use of Acetaminophen or Vitamin C