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SIRS, Sepsis, Severe Sepsis, Septic Shock, and MOF

SIRS, Sepsis, Severe Sepsis, Septic Shock, and MOF. Bryan Imayanagita Trauma Research Associates Program 6/1/12. Systemic Inflammatory Response Syndrome (SIRS). Criteria established in 1992 Related to systemic inflammation, organ dysfunction/failure

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SIRS, Sepsis, Severe Sepsis, Septic Shock, and MOF

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  1. SIRS, Sepsis, Severe Sepsis, Septic Shock, and MOF Bryan Imayanagita Trauma Research Associates Program 6/1/12

  2. Systemic Inflammatory Response Syndrome (SIRS) • Criteria established in 1992 • Related to systemic inflammation, organ dysfunction/failure • Classified as infectious and non infectious • Non infectious causes: trauma, burn, pancreatitis, ischemia, hemorrhage, etc

  3. SIRS Criteria • Temp: <36 °C (96.8 °F) or >38 °C (100.4 °F) • HR: >90/min • RR: >20/min or PaCO2<32 mmHg (4.3 kPa) • WBC: <4x109/L (<4000/mm³), >12x109/L (>12,000/mm³)

  4. Sepsis • SIRS + documented infection • Evidence: • WBC in sterile fluid (urine, CSF) • Perforated viscus • Abnormal CXR (pneumonia)

  5. Severe Sepsis • Sepsis associated with organ dysfunction, hypotension, or hypoperfusion abnormalities • lactic acidosis • Oliguria • acute alteration in mental status • Can be maintained by IVF

  6. Septic Shock • Refractory hypotension • Significantly decreased tissue profusion • Organ failure • Ischemia • Cannot be maintained by IVF • 25-50% mortality

  7. Multi Organ Failure • Homeostasis cant be maintained without intervention • 2 or more organ systems • Stage 1 the patient has increased volume requirements and mild respiratory alkalosis which is accompanied by oliguria, hyperglycemia and increased insulin requirements. • Stage 2 the patient is tachypneic, hypocapnic and hypoxemic. Moderate liver dysfunction and possible hematologic abnormalities. • Stage 3 the patient develops shock with azotemia and acid-base disturbances. Significant coagulation abnormalities. • Stage 4 the patient is vasopressor dependent and oliguric or anuric. Ischemic colitis and lactic acidosis follow.

  8. Treatment • Antibiotics • Early Goal Directed Therapy (EGDT) • CVP at 10-12 cm (usually isotonic crystalloid) • If MAP <65mm Hg or BP<90  vasopressors/dialators • SVO2 optimization by transfusion • Monitor urine output • Reduced mortality by 16%

  9. Treatment (Cont.) • Vasopressors: norepinephrine, dopamine • Corticosteroids • Most beneficial in septic shock phase or ARDS

  10. Prognosis • 25-35% severe sepsis and 40-60% of septic shock patients die within 30 days • Severity of underlying disease most strongly influences risk of death

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