Sepsis Multicast 1/5
In Show #1/5 we will provide an introduction to the series, review some sepsis core content and discuss the debated "septic, normotensive, LA >4" patient.
Core Content Review
(from Marino's ICU Book or elsewhere as cited)
- Pathophysiology:
- Microbial invasion precipitates inflammatory response through release of inflammatory cytokines (mainly IL-1α, IL-1β, IL-6, and TNF-α). The hope is to eliminate the threat without affecting the host.
- Persistent/widespread inflammation produces tissue damage.
- Damaged tissue triggers more inflammation.
- Proinflammatory cytokines promote dysregulated coagulation which begets more tissue damage and inflammation.
- Neutrophils are activated by inflammatory cytokines and undergo a respiratory burst. O2 consumption increases and reactive oxygen species (ROS) are generated, released via degranulation.
- ROS cause further tissue damage and activation of the inflammatory response.
- The INFLAMMA-CO-OXIDATIVE HURRICAINE is a self-sustaining process that ultimately produces organ dysfunction.
- See these open access articles on organ dysfunction in sepsis for more information.
Definitions & Criteria
- The definition of sepsis is 'a life threatening condition that arises when the body's response to infection injures its own tissue.'
- Diagnostic Criteria for sepsis vary
OLD sepsis criteria
Systemic inflammatory response syndrome (SIRS) |
2/4 of the following
|
(SIRS + does not necessarily = infection) |
Sepsis |
SIRS + documented or suspected infection |
|
Severe sepsis |
Sepsis + organ dysfunction |
Organ dysfunction, defined as:
|
Septic shock |
Severe sepsis + hypotension refractory to adequate volume resuscitation |
Typical pattern = distributive: low CVP / high CO / low SVR |
Multiorgan dysfunction syndrome (MODS) |
Severe sepsis w/ involvement of more than one organ system |
|
Multiorgan failure (MOF) |
Subsequent failure of multiple organ systems |
New criteria from @FOAMpodcast
- Severe sepsis is OUT
- Sepsis and septic shock remain
Sepsis |
Documented / suspected infection +
OR Rise in SOFA score by > 2 |
Mortality 10% |
Septic shock |
Sepsis + Persistent hypotension requiring pressor support for MAP >65 AND Lactate > 2 |
Mortality 40% |
Sequential Organ Failure Assessment (SOFA) score
A mortality prediction score that assesses the degree of organ dysfunction in 6 different systems:
- Respiratory
- Nervous
- Cardiovascular
- Liver
- Coagulation
- Kidneys
See MDCALC's Clinical Scoring tool
We conclude our episode in discussing that the hallmark of sepsis care is probably just frequent re-evaluation and early intervention.