Sepsis resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Definition

• Sepsis = Infection + SIRS

• The presence of systemic inflammatory syndrome (SIRS) is due to many factors. The presence of infection increases the chances of sepsis and increase the SIRS criteria .

• The endothelial dysfunction is the main trigger transforming the localized infection into systemic organ dysfunction

• There is no definitive biomarkers have been associated with the endothelial dysfunction of sepsis.

SIRS is diagnosed by 2 or more of the following:

• Tachycardia > 90 bpm
• Tachypnea > 20 breaths per minute or on blood gas, a P_aCO₂ < 32 mm Hg
• Temperature < 36 (96.8 °F) or > 38 °C (100.4 °F)
• White blood cell count < 4000 cells/mm³ or > 12000 cells/mm³ (< 4 x 10⁹ or > 12 x 10⁹ cells/L), or > 10% band forms (immature white blood cells / bandemia).

Sepsis is diagnosed by at least 1of the following signs of organ failure: [HOME]

• Hypoxemia (arterial oxygen tension [PaO2] < 72 mm Hg at fraction of inspired oxygen [FiO2] 0.21; overt pulmonary disease not the direct cause of hypoxemia)
• Oiguria (urine output < 30 mL or 0.5 mL/kg for at least 1 h)
• Mental status alteration
• Elevated plasma lactate level > 4mg

Severe Sepsis

• Sepsis + organ dysfunction
• Organ damage can present as decreased urine output, acute kidney injury, and elevated liver function tests.

Multiple Organ Dysfunction Syndrome (MODS) is the presence of altered organ function in a acutely ill patient whom homeostasis cannot be maintained without intervention.

Septic Shock

• Severe sepsis + persistent hypotension after adequate fluid challenge.

Management

Aggressive therapy with hemodynamic monitoring

Do's

• Appropriate antibiotic administration has a significant influence on mortality.
• Initiating broad-spectrum coverage until the specific organism is cultured and antibiotic sensitivities are determined is important.