Monday, July 19, 2010

Sepsis & SIRS

Infection:  Inoculation of pathogen into normally sterile tissue

Systemic inflammatory response is triggered by ischaemc, inflammation, trauma, infection to protect the host from the damaging effect of insult. However, the response can be overexaggerated when the damage and insult is too great.

Systemic inflammatory response syndrome (SIRS) criteria---> 2 or more of the following:
  • Temp: <36 or >38
  • HR: > 90 bpm
  • RR: > 20/ min
  • WCC: >12 X 10^9/L or <4X10^9/L
  • MAP: <65 mmHg (Systolic BP < 90 mmHg/ Diastolic BP < 60mmHg)
Sepsis: SIRS with the presence of infection (documented).
Severe sepsis : SIRS with organ dysfunction (SOFA criteria)
Septic shock : Sepsis-induced hypotension despite fluid resuscitation

Sepsis Organ Failure Assessment (SOFA) criteria

Goal in treating sepsis :
1. MAP > 65 mmHg (To maintain BP > 90/60 mmHg)
2. ScvO2 > 70%
3. CVP: 8-12mmHg
4. Urine output > 0.5ml/kg/h

Recap MAP calculation:
MAP : (systolic - diastolic)1/3 + diastolic

Edited by: Wong Yee Ming


~YM~ said...

I thought for SIRS, the criteria are:

Temp: <36 or >38
HR: > 90 bpm
RR: > 20/ min
WCC: >12 X 10^9/L or <4X10^9/L
MAP: <65 mmHg

Note: There is a lower border for normal temperature and WCC. :P

小豐 said...

yee ming is correct.
added with:
PaCO2 < 32mmHg (alternative for RR component)

added: severe sepsis should be = Sepsis + Oragan dysfunction, hypoperdusion or hypotension.
organ hypoperfusion may inculded lactic acidosis, oliguria, acute alteration in mental status.. and ect..

Septic shock / SIRS shock = Sepsis induced arterial hypotension

by ACCP/SCCM consensus

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