Important Definitions in Sepsis
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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 Important Definitions in Sepsis Presentation Transcript

  • Important Definitions in Sepsis Dr Rosalind O’Reilly
  • Overview • Origins of definitions • Infection • Bacteraemia • Systemic Inflammatory Response Syndrome • Sepsis • Severe Sepsis • Multi Organ Dysfunction Syndrome
  • 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
  • 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 – 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
  • 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
  • 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/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)
  • 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 direct response to the insult – is a consequence of the host’s response
  • 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
  • Questions???