Sepsis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Sepsis is a serious medical condition characterized by a whole-body inflammatory state caused by infection. Traditionally the term sepsis has been used interchangeably with septicaemia and septicemia ("blood poisoning"). However, these terms are no longer considered synonymous; septicemia is considered a subset of sepsis.
Definition of sepsis
Sepsis is considered present if infection is highly suspected or proven and two or more of the following systemic inflammatory response syndrome (SIRS) criteria are met:[1]
- Heart rate > 90 beats per minute
- Body temperature < 36 (96.8 °F) or > 38 °C (100.4 °F)
- Hyperventilation (high respiratory rate) > 20 breaths per minute or, on blood gas, a PaCO2 less than 32 mm Hg
- White blood cell count < 4000 cells/mm³ or > 12000 cells/mm³ (< 4 x 109 or > 12 x 109 cells/L), or greater than 10% band forms (immature white blood cells).
Consensus definitions however continue to evolve with the latest expanding the list of signs and symptoms of sepsis to reflect clinical bedside experience.[2]
Severe sepsis
Patients are defined as having "severe sepsis" if they have sepsis plus
- signs of systemic hypoperfusion
- Either end organ dysfunction or
- a serum lactate greater than 4 mmol/dL.
Septic shock
Septic shock (sepsis with refractory arterial hypotension).
Neonatal sepsis
The criteria for diagnosing an adult with sepsis do not apply to infants under one month of age. In infants, only the presence of infection plus a "constellation" of signs and symptoms consistent with the systemic response to infection are required for diagnosis.
Definition of SIRS
Criteria for SIRS were agreed in 1992.[3] SIRS can be diagnosed when two or more of the following are present[4][5][6][7]:
- Heart rate > 90 beats per minute
- Body temperature < 36 or > 38°C
- Tachypnea (high respiratory rate) > 20 breaths per minute or, on blood gas, a PaCO2 < 4.3 kPa (32 mm Hg)
- White blood cell count < 4000 cells/mm³ or > 12000 cells/mm³ (< 4 x 109 or > 12 x 109 cells/L), or the presence of greater than 10% immature neutrophils.
Severe SIRS
- When two or more of the systemic inflammatory response syndrome criteria are met without evidence of infection, patients may be diagnosed simply with "SIRS."
- Patients with SIRS and acute organ dysfunction may be termed "severe SIRS."
Difference between SIRS and sepsis
SIRS with a suspected or proven infection is called sepsis.
Simply stated:
Complications of SIRS
SIRS can result in the multiple organ dysfunction syndrome.
See also
References
- ↑ Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992 Jun;101(6):1644-55. PMID 1303622.
- ↑ Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G; SCCM/ESICM/ACCP/ATS/SIS. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003 Apr;31(4):1250-6.
- ↑ "American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis". Crit. Care Med. 20 (6): 864–74. 1992. PMID 1597042.
- ↑ 4.0 4.1 Irwin RS, Cerra FB, Rippe JM. Irwin and Rippe's Intensive Care Medicine. 5th Ed. Lippincott Williams & Wilkins. Hagerstown, MD. 2003. ISBN 0-7817-1425-7. Publisher's information on the book.
- ↑ 5.0 5.1 Marino PL. The ICU Book. 2nd Ed. Lippincott Williams & Wilkins. Hagerstown, MD. 1998. ISBN 0-683-05565-8. Publisher's information on the book.
- ↑ Sharma S, Steven M. Septic Shock. eMedicine.com, URL: http://www.emedicine.com/MED/topic2101.htm Accessed on Nov 20, 2005.
- ↑ Tslotou AG, Sakorafas GH, Anagnostopoulos G, Bramis J. Septic shock; current pathogenetic concepts from a clinical perspective. Med Sci Monit. 2005 Mar;11(3):RA76-85. PMID 15735579. Full Text.