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Understanding Sepsis: Criteria, Definitions, Pathogenesis, and Treatment, Study notes of Pathophysiology

An in-depth analysis of sepsis, including its criteria, older and consensus definitions, pathogenesis, and treatment. It covers the organ dysfunction assessment (SOFA) score, qSOFA criteria for suspected infection, and the clinical criteria for septic shock. The document also discusses the limitations of SIRS and the role of late-acting mediators such as HMGB1 and MIF in the pathogenesis of sepsis and MODS.

Typology: Study notes

2021/2022

Uploaded on 09/12/2022

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S E P S I S :
UPDATE GUIDELINE 2016:
WHAT’S DIFFERENCES THAN
GUIDELINE 2001 ?
Erwin Budi Cahyono
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Download Understanding Sepsis: Criteria, Definitions, Pathogenesis, and Treatment and more Study notes Pathophysiology in PDF only on Docsity!

S E P S I S :

UPDATE GUIDELINE 2016:

WHAT’S DIFFERENCES THAN

GUIDELINE 2001?

Erwin Budi Cahyono

 Definitions  Epidemiology  Pathophysiology  Treatment  Future directions

Older Definitions

SEPSIS :

 Evidence of SIRS accompanied by known or suspected infection. Severe SEPSIS :  Sepsis accompanied by hypoperfusion or organ dysfunction.  Cardiovascular :  SBP<90 mmhg/MAP<70 for at least 1 hr despite adequate volume resuscitation or the use of vasopressors to achieve the same goals.  Renal :  Urine output <0.5 ml/kg/hr or Acute Renal Failure.  Pulmonary :  PaO2/FiO2 <250 if other organ dysfuncton is present or <200 if the lungs is the only dysfunctional organ.

Older Definitions

Severe SEPSIS (contd) :  Gastrointestinal :  Hepatic dysfunction (hyperbilirubinemia,Elevated transaminases  CNS :  Alteration in Mental status (delirium)  Hematologic :  Platelet count of <80,000/mm3 or decreased by 50% over 3 days/DIC  Metabolic :  PH<7.30 or base deficit >5.0 mmol/L  Plasma lactate >1.5 upper limit of normal. Septic Shock :  Severe Sepsis with persistent hypoperfusion or hypotension despite adequate fluid resuscitation

Sepsis 1

  • Introduced the term “systemic inflammatory response syndrome” (SIRS).
  • SIRS is considered to be present when patients have more than one of the following clinical findings: - Body temperature higher than 38 °C or lower than 36 °C - Heart rate higher than 90/min - Hyperventilation evidenced by respiratory rate higher than 20/min or PaCO2lower than 32 mmHg - White blood cell count higher than 12,000 cells/ μl or lower than 4,000/ μl

Sepsis 1

  • Sepsis
    • SIRS plus infection
  • Severe sepsis
    • sepsis associated with organ dysfunction, hypoperfusion or hypotension
  • Septic shock
    • sepsis with arterial hypotension despite “adequate” fluid resuscitation

Sepsis 2

  • Unchanged concepts of sepsis, severe sepsis, and septic shock
  • Original SIRS overly sensitive and nonspecific - > increased complexity of scoring system.

Expanded SIRS criteria

Sepsis

  • Sepsis clinical criteria: organ dysfunction is defined as an increase of 2 points or more in the Sequential Organ Failure Assessment (SOFA) score - for patients with infections, an increase of 2 SOFA points gives an overall mortality rate of 10%
  • Patients with suspected infection who are likely to have a prolonged ICU stay or to die in the hospital can be promptly identified at the bedside with qSOFA (“HAT”); i.e. 2 or more of: - H ypotension: SBP less than or equal to 100 mmHg - A ltered mental status (any GCS less than 15) - T achypnoea: RR greater than or equal to 22

Septic Shock

  • Septic shock is ‘a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality.’
  • Septic shock clinical criteria: Sepsis and (despite adequate volume resuscitation) both of: - Persistent hypotension requiring vasopressors to maintain MAP greater than or equal to 65 mm Hg, and - Lactate greater than or equal to 2 mmol/L
  • With these criteria, hospital mortality is in excess of 40%

Epidemiology

 Current estimates suggest that over 750,000 cases of Sepsis are diagnosed annually, resulting in more than 200,000 deaths.  The incidence rate for Sepsis has been increasing over the past two decades, driving an increase in the number of deaths despite a decline in case-fatality rates.  Sepsis is the tenth leading cause of death in the United States and accounts for more than 17 billion dollars in direct healthcare expenditures.  Risk factors include age > 65 years, male, non- whites.  A primary site of infection cannot be established in 10% of patients with severe Sepsis/SIRS.

Epidemiology:

Epidemiology : Causative organism

Pathophysiology of Sepsis