Sepsis is a systemic inflammatory response to infection that can lead to organ dysfunction and death. It is a major cause of death in intensive care units. The incidence of sepsis is rising due to an aging population and increased use of invasive medical procedures and devices. Sepsis progresses through a spectrum from systemic inflammatory response syndrome to severe sepsis with organ dysfunction to septic shock with hypotension and perfusion abnormalities if not treated promptly.

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7. Systemic Inflammatory Response Syndrome (SIRS) Systemic inflammatory response to a non-specific insult that includes ≥ 2 of the following symptoms: – Temperature > 38 C or < 36 C – Heart rate > 90 beats/min – Respiratory rate > 20/min, or paO2 < 32 mmHg – WBC > 12,000/mm3 or < 4,000/mm3, or > 10% bands

8. Sepsis Syndrome Sepsis – ‘ SIRS’ response with presumed/confirmed infection Severe Sepsis – Sepsis associated with organ dysfunction, hypoperfusion (lactic acidosis, oliguria, altered mental status etc.), or hypotension (SBP < 90 mmHg or ↓ SBP > 40 mmHg) Septic Shock – Sepsis with perfusion abnormalities and hypotension despite adequate fluid resuscitation

9. Multiple Organ Dysfunction Syndrome (MODS) Multiple Organ Failure – Presence of severe dysfunction of at least two organ system lasting for more than 24 hours. – Four or more systems - mortality near to 100 percent

12. Compensatory anti-inflammatory response syndrome (CARS) Overcompensating Anti-inflammatory Response A syndrome in which anti-inflammatory mediator release overcompensates for the systemic inflammatory response leading to a state of immune suppression, increased susceptibility to infection, and impaired recovery.

14. Capillary Damage Capillary Damage during Systemic Inflammatory Response Syndrome (SIRS)

24. Multiple Cascades

25. Homeostasis Gets Lost

26. Sepsis 101

48. Xigris (Activated Protein C)

50. Steroids & Septic Shock

53. The End ?