Dr .Syed Inayathullah Head Of ICU Meeqat General Hospital, Medina ,KSA

1. Sepsis
Dr .Syed Inayathullah
Head Of ICU Meeqat General Hospital, Medina ,KSA
.

2. Statistics
Over 750,000 cases of sepsis per year in the US
Severe sepsis : 2% of all US hospital discharges
One of the top 10 causes of death in US and 2nd leading cause
of death in noncoronary ICU patients
Over 200,000 deaths per year due to sepsis in US
In hospital mortality from approx. 18%-29%
Mortality in septic shock is much higher … 50 %
ProCESS study of 1,341 patients with septic shock …in hospital
mortality at 60 days 19.3% and at 90% 32.1%

3. General risk factors
• IV lines and catheters ( central lines, foleys catheter)
• Mechanical ventilation
• Chronic ulcers and wounds
• Recent surgery
• Severe disease ( cancer, AIDS, liver disease)
• Immunosuppression
• ICU care
• Prolonged hospitalization
• Postpartum complications ( endometritis, placental retention,cesarean or vaginal wound infection)
• Invasive procedures
• Advance age ( > 65 years)
• Alcoholism and IV drug use

4. Pathophysiology
• Basic terminology
• SIRS: Systemic inflammatory response syndrome
• Sepsis: SIRS from infection
• Severe sepsis: Sepsis + Organ hypoperfusion
• Septic shock: Sepsis + refractory severe hypotension

6. Infectious or non infectious insult
SIRS
Haemodynamic:
Vasodilation
Myocardial depression
Redistribution/shunting
Microvascular:
Endothelial function
Microemboli
Gut mucosa ischemia
O2 hypoxia:
Oxygen
Cell
Mitochondria
Cellular
damage/apoptosis

7. Cardiovascular system effects of SIRS and
Sepsis
• Hypotension: Activation of endothelial NO synthase + decreased
vasopressin levels --- increased vascular permeability…. Low PVR and
hypotension
+ Microvascular injury: Adhesion protein upregulation + impaired
anticoagulation+immune cell, fibrinolytic and complement system
activation + decreased RBC flexibility microvascular injury,
immune complex cell deposition, capillary clogging, decrease o2
transfer capacity, clotting abnormalities =
Organ damage + Shock + Death
Mechanism: Hypo-oxygenation,tissue hypoperfusion Organ
damage, MODS Death.

8. Diagnosis

10. Septic Shock
• Septic shock = Severe sepsis + hypotension requiring low dose
vasopressor despite adequate resuscitation
• Refractory septic Shock = Severe sepsis + hypotension requiring high-
dose vasopressors despite adequate fluid resuscitation
• Vasopressor doses in septic shock and refractory septic shock
• Septic shock : MAP < 60mm Hg DA> 5mcg/kg/min, NE < 0.25
mcg/kg/min, Epi<0.25 mc/kg/min
• Refractory shock: MAP < 60mm Hg DA > 15mcg/kg/min, NE
>0.25mcg/kg/min, Epi > 0.25mcg/kg/min

11. management

14. Antibiotic therapy initially

15. .
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