Important Definitions in Sepsis
Dr Rosalind O’Reilly
Overview
• Origins of definitions
• Infection
• Bacteraemia
• Systemic Inflammatory Response Syndrome
• Sepsis
• Severe Se...
Origin of Definitions
• Initially defined in 1991
– Consensus panel convened by ACCP and SSCM
• Reconsidered in 2001 Inter...
INFECTION
Invasion
of
normally sterile tissue
by
organisms
BACTERAEMIA
presence
of
viable bacteria
in
blood
SYSTEMIC INFLAMMATORY
RESPONSE SYNDROME
clinical syndrome
from
dysregulated inflammatory response
to
noninfectious insult
SEPSIS
Infection
+
systemic manifestations of infection
Systemic Manifestations
• General variables
– Temp >38.3 °C <36 °C
– HR >90 /min
– Tachypnoea
– Altered mental status
– Si...
Systemic Manifestations
• Organ dysfunction
– Arterial hypoxaemia
(PaO2/FiO2 <40kPa /
300mmHg)
– Acute oliguria (urine
out...
SEVERE SEPSIS
Sepsis
+
sepsis-induced organ dysfunction
or
tissue hypoperfusion
Tissue hypoperfusion or organ dysfunction
• Sepsis-induced hypotension
• Lactate above upper limits
• Urine output < 0.5mL...
SEPTIC SHOCK
Sepsis-induced hypotension
persisting
despite adequate fluid resuscitation
MULTI ORGAN DYSFUNCTION
SYNDROME
Progressive organ dysfunction
+
homeostasis cannot be maintained
without intervention
MODS
• PRIMARY
– well-defined insult
– early organ dysfunction
– directly attributable
• SECONDARY
– organ failure not in
...
MODS
• No universally accepted criteria for individual
organ dysfunction in MODS
• Progressive abnormalities of
– PaO2/FiO...
Questions???
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Important Definitions in Sepsis

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  • Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock werethe American College of Chest Physicians (ACCP) and Society of Critical Care Medicine (SCCM)American Thoracic Society, European society of intensive care medicine, surgical infection society
  • such as an autoimmune disorder, pancreatitis, vasculitis, thromboembolism, burns or surgery
  • As the presence (probable or documented) of
  • which may be defined as 30mL/kg of crystalloids. Septic shock is of vasodilatory or distributive shock (ie it results from a marked reduction in SVR, often associated with an increase in cardiac output
  • in an acutely ill patient, such thatIt is at the severe end of the severity of illness spectrum of both SIRS and sepsis
  • (eg ARDS in patients with pancreatitis)
  • Important Definitions in Sepsis

    1. 1. Important Definitions in Sepsis Dr Rosalind O’Reilly
    2. 2. Overview • Origins of definitions • Infection • Bacteraemia • Systemic Inflammatory Response Syndrome • Sepsis • Severe Sepsis • Multi Organ Dysfunction Syndrome
    3. 3. Origin of Definitions • Initially defined in 1991 – Consensus panel convened by ACCP and SSCM • Reconsidered in 2001 International Sepsis Definitions Conference – ACCP, SCCM, ATS, ESICM, SIS • Reconsidered again 2012 – SSCM and ESICM
    4. 4. INFECTION Invasion of normally sterile tissue by organisms
    5. 5. BACTERAEMIA presence of viable bacteria in blood
    6. 6. SYSTEMIC INFLAMMATORY RESPONSE SYNDROME clinical syndrome from dysregulated inflammatory response to noninfectious insult
    7. 7. SEPSIS Infection + systemic manifestations of infection
    8. 8. Systemic Manifestations • General variables – Temp >38.3 °C <36 °C – HR >90 /min – Tachypnoea – Altered mental status – Significant oedema or positive fluid balance >20mL/kg over 24hr – Hyperglycaemia >7.7mmol/L in absence of diabetes • Inflammatory variables – WCC >12, <4 x109/L – Normal WCC >10%immature – CRP > 2SD – Procalcitonin >2SD • Haemodynamic variables – SBP <90mmHg or decrease >40mmHg – MAP <70mmHg
    9. 9. Systemic Manifestations • Organ dysfunction – Arterial hypoxaemia (PaO2/FiO2 <40kPa / 300mmHg) – Acute oliguria (urine output <0.5mL/kg/hr for at least 2 hrs despite adequate fluid resuscitation) – Creatinine increase 44.2μmol/L – Coagulation abnormalities (INR >1.5 or APTT >60s) – Ileus (absent bowels sounds) – Thrombocytopenia (plt <100 x103/mm3) – Hyperbilirubinaemia • Tissue perfusion variables – Hyperlactatemia >1mmol/L – Decreased capillary refill or mottling
    10. 10. SEVERE SEPSIS Sepsis + sepsis-induced organ dysfunction or tissue hypoperfusion
    11. 11. Tissue hypoperfusion or organ dysfunction • Sepsis-induced hypotension • Lactate above upper limits • Urine output < 0.5mL/kg/hr for more than 2 hrs despite adequate fluid resuscitation • Acute lung injury with PaO2/FiO2 < 33kPa (250mmHg) in the absence of pneumonia as infection or source • Acute lung injury with PaO2/FiO2 in the presence of pneumonia as infection source • Creatinine > 176.8 μmol/L • Bilirubin >32 μmol/L • Platelet count <100 x109 /mm3 • Coagulopathy (PT or APTT > 1.5 x control)
    12. 12. SEPTIC SHOCK Sepsis-induced hypotension persisting despite adequate fluid resuscitation
    13. 13. MULTI ORGAN DYSFUNCTION SYNDROME Progressive organ dysfunction + homeostasis cannot be maintained without intervention
    14. 14. MODS • PRIMARY – well-defined insult – early organ dysfunction – directly attributable • SECONDARY – organ failure not in direct response to the insult – is a consequence of the host’s response
    15. 15. MODS • No universally accepted criteria for individual organ dysfunction in MODS • Progressive abnormalities of – PaO2/FiO2 ratio – Platelet count – Serum bilirubin – Serum creatinine – Glasgow coma score – Hypotension
    16. 16. Questions???

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