|
|
(31 intermediate revisions by 2 users not shown) |
Line 1: |
Line 1: |
| ==Definition==
| |
|
| |
|
| Sepsis is a systemic, deleterious host response to infection, manifested as multi system organ dysfunction plus hypotension, that is not readily reversible with fluid resuscitation.
| |
|
| |
| ==Diagnostic Criteria For Sepsis (Documented/Suspected Infection Plus Inflammatory variables Plus One of The Organ Dysfunction)==
| |
|
| |
| :'''General variables'''
| |
| :*Fever > 38.3°C
| |
| :*Hypothermia ( core temperature < 36°C )
| |
| :*Heart rate > 90/min–1 or > 2 SD above the normal value for age
| |
| :*Tachypnea
| |
| :*Altered mental status
| |
| :*Edema
| |
| :*Positive fluid balance ( > 20 mL/kg over 24 hr)
| |
| :*Hyperglycemia ( plasma glucose > 140 mg/dL or 7.7 mmol/L ) in the absence of diabetes
| |
|
| |
| :'''Inflammatory variables'''
| |
| :*Leukocytosis ( WBC count > 12,000 µL–1 )
| |
| :*Leukopenia ( WBC count < 4000 µL–1 )
| |
| :*Immature WBCs forms are > 10% with normal count
| |
| :*Plasma C-reactive protein > 2 SD above the normal value
| |
| :*Plasma procalcitonin > 2 SD above the normal value
| |
|
| |
| :'''Hemodynamic variables'''
| |
| :*Arterial hypotension after 30 ml/kg fluid bolus ( SBP < 90 mm Hg, MAP < 70 mm Hg, or an SBP decrease > 40 mm Hg in adults or < 2 SD below normal for age )
| |
|
| |
| :'''Organ dysfunction variables'''
| |
| :*Arterial hypoxemia ( Pao2/Fio2 < 300 )
| |
| :*Acute oliguria ( urine output < 0.5 mL/kg/hr for at least 2 hrs despite adequate fluid resuscitation )
| |
| :*Creatinine increase > 0.5 mg/dL or 44.2 µmol/L
| |
| :*Coagulation abnormalities ( INR > 1.5 or aPTT > 60 Sec )
| |
| :*Ileus ( absent bowel sounds )
| |
| :*Thrombocytopenia ( platelet count < 100,000 µL–1 )
| |
| :*Hyperbilirubinemia ( plasma total bilirubin > 4 mg/dL or 70 µmol/L )
| |
|
| |
| :'''Tissue perfusion variables'''
| |
| :*Hyperlactatemia > 1 mmol/L
| |
| :*Decreased capillary refill or mottling
| |
|
| |
| ==Diagnostic Criteria for Severe Sepsis (sepsis induced hypoperfusion or organ dysfunction)==
| |
| Includes any one of the following caused due to the infection:
| |
| :* Sepsis-induced hypotension
| |
| :* Lactate above upper limits laboratory normal
| |
| :* Urine output < 0.5 mL/kg/hr for more than 2 hrs despite adequate fluid resuscitation
| |
| :* Acute lung injury with Pao2/Fio2 < 250 in the absence of pneumonia as infection source
| |
| :* Acute lung injury with Pao2/Fio2 < 200 in the presence of pneumonia as infection source
| |
| :* Creatinine > 2.0 mg/dL (176.8 μmol/L)
| |
| :* Bilirubin > 2 mg/dL (34.2 μmol/L)
| |
| :* Platelet count < 100,000 μL
| |
| :* Coagulopathy (international normalized ratio > 1.5)
| |