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SEPSIS

Learn about SIRS, Sepsis, Severe Sepsis, and Septic Shock in pediatric patients. Understand criteria, definitions, and organ dysfunctions associated with septic shock. Explore inflammatory changes after trauma, infection, burns, pancreatitis, and more.

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SEPSIS

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  1. SEPSIS Rajat Pareek, MD

  2. Pediatric SIRS Non specific inflammatory changes occuring after trauma, infection, burns, pancreatitis and other diseases.

  3. Definition of SIRS • Atleast 2 /4 cirteria, one of which MUST be abnormal Temp/abnormal leucocyte count • Core temp >38.5, < 36 • Tachycardia: >2SD above normal for age in absence of external stimulus, chr drugs, painful stimuli/ unexplained persistent elevation over a ½-4hr time frame OR children <1 yr: bradycardia, ie mean HR < 10th% for age in absence of vagal stimulus/B-blocker drugs or CHD/unexplained depression over a ½ hr time period

  4. Def. contd 3. Resp rate <2 SD above normal for age or mech ventilation in absence of underlying neuromuscular disease/GA 4. WBC elevated or depressed for age (not due to chemo induced leucopenia) OR >10% immature neutrophils.

  5. Definition of INFECTION • A suspected or proven (by Culture, Tissue stain, PCR) infection caused by any pathogen OR Clinical syndrome asso with high probablity of infection. Evidence of infection: PE findings, imaging, labs ie CXR, petechial rash, Increased WBCs in sterile body fluids, etc.

  6. Definition of SEPSIS SIRS + INFECTION= SEPSIS

  7. Definition of SEVERE SEPSIS SEPSIS + One of the foll: 1. CV organ dysfunction 2. ARDS 3. >=2 more other organ dysfunction

  8. Definition of SEPTIC SHOCK SEPSIS + CV ORGAN DYSFUN = SEPTIC SHOCK

  9. Organ Dysfunction • CV Dysfunction: • Hypotension < 5th% for age OR SBP < 2SD below normal for age OR 2. Vasoactive drug to maintain BP (dopamine > 5mcg/kg/min or dobutamine/epi/norepi at any dose) OR • 2 of the foll: • Unexplained metabolic acidosis: base deficit >5 • Increased art lactate >2 times upper limit of normal • Oliguria: UO < 0.5ml/kg/hr • Cap refill >5 sec • Core to peripheral temp gap > 3C

  10. Organ Dysfunction • Respiratory Dysfunction • PaO2/FiO2 <300 in absence of CHD/Pre existing lung disease OR • PaCO2 > 65 torr or 20 mm Hg over baseline PaCO2 OR 3.

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