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Sepsis: Difference between revisions
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(Created page with "<section begin="pathophysiology" /><section begin="clinical biochemistry" />'''Sepsis''' is an acute life-threatening condition characterised by organ dysfunction caused by a dysregulated host response to infection, usually bacterial. It’s related to SIRS in pathomechanism. It has a very high mortality rate and can lead to multiple organ dysfunction syndrome (MODS) and death.<section end="clinical biochemistry" /> == Definition == Sepsis is accurately defined as “A...") |
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<section begin="pathophysiology" /><section begin="clinical biochemistry" />'''Sepsis''' is an acute life-threatening condition characterised by organ dysfunction caused by a dysregulated host response to infection, usually bacterial. It’s related to SIRS in pathomechanism. It has a very high mortality rate and can lead to multiple organ dysfunction syndrome (MODS) and death.<section end="clinical biochemistry" /> | <section begin="pathophysiology" /><section begin="clinical biochemistry" />'''Sepsis''' is an acute life-threatening condition characterised by organ dysfunction caused by a dysregulated host response to infection, usually bacterial. It’s related to [[systemic inflammatory response syndrome]] (SIRS) in pathomechanism. It has a very high mortality rate and can lead to [[multiple organ dysfunction syndrome]] (MODS) and death.<section end="clinical biochemistry" /> | ||
'''Septic shock''' is defined as “A subset of sepsis in which underlying circulatory and cellular or metabolic abnormalities lead to substantially increased mortality risk.” As the name implies it implies the state where a person has sepsis and circulatory shock, often of the distributive type. A person is said to be in septic shock if: | |||
Septic shock is defined as “A subset of sepsis in which underlying circulatory and cellular or metabolic abnormalities lead to substantially increased mortality risk.” As the name implies it implies the state where a person has sepsis and circulatory shock, often of the distributive type. A person is said to be in septic shock if: | |||
* The patient has sepsis, and: | * The patient has sepsis, and: | ||
* Vasopressors are required to maintain a mean blood pressure of above 65 mmHg, and: | * Vasopressors are required to maintain a mean blood pressure of above 65 mmHg, and: | ||
* The serum level of lactate is > 2.0 mM | * The serum level of lactate is > 2.0 mM | ||
== Etiology == | == Etiology == | ||
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** DIC | ** DIC | ||
<section begin="clinical biochemistry" /> | <section begin="clinical biochemistry" /> | ||
== Diagnosis == | == Diagnosis and evaluation == | ||
Diagnosis of sepsis can be difficult. A series of criteria called qSOFA (quick SOFA) can be used to | Organ dysfunction must be present for the diagnosis of sepsis. The definition of “organ dysfunction” can itself be difficult to accurately establish. To help with this, a set of assessment criteria called “sequential organ failure assessment score” or SOFA score can help. These criteria assess the function of important organ systems like lungs, liver, CNS, kidneys, circulation and the coagulation and gives scores from 0 (normal function) to 4 (worst function). The score for each organ system is then summed up. Acute organ dysfunction is defined as an acute change in total SOFA score of 2 points or more. | ||
''Sepsis used to be evaluated by the criteria of “systemic inflammatory response syndrome” (SIRS), but that is not recommended anymore. Sepsis now has its own criteria (SOFA).'' | |||
Diagnosis of sepsis can be difficult. A series of criteria called qSOFA (quick SOFA) can be used to screen for sepsis. qSOFA is said to be positive of 2 or more of the following criteria are present: | |||
* Altered mental status (GCS < 15) | * Altered mental status (GCS < 15) | ||
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* Systolic blood pressure < 100 mmHg | * Systolic blood pressure < 100 mmHg | ||
If qSOFA is positive, blood cultures should be performed to look for the pathogen | If qSOFA is positive, blood cultures should be performed to look for the pathogen and the patient should be evaluated for organ dysfunction according to the SOFA system. Blood tests should be performed to measure the following: | ||
* <abbr>CBC</abbr> (complete blood count) | * <abbr>CBC</abbr> (complete blood count) | ||
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<section end="clinical biochemistry" /> | <section end="clinical biochemistry" /> | ||
== Treatment == | == Treatment == | ||
Empiric antibiotic treatment should begin immediately after blood cultures has been drawn; mortality increases the longer the patient goes without antibiotic therapy. The goal should be to administer antibiotics | Management according to the 2016 surviving sepsis campaign (SSC). The therapeutic goals are: | ||
* Central venous pressure 8 – 12 mmHg | |||
* Mean arterial pressure > 65 mmHg | |||
* Urine output > 0,5 mL/bwkg/hour | |||
* SvcO2 > 70% | |||
Empiric antibiotic treatment should begin immediately after blood cultures has been drawn; mortality increases the longer the patient goes without antibiotic therapy. The goal should be to administer antibiotics within 1 hour of recognition of the diagnosis. Any source of infection, like foreign bodies, abscesses or infected wounds should be assessed and treated appropriately. | |||
Depending on the patient’s condition, fluid therapy, intubation and/or vasopressors might be necessary to maintain ventilation and circulation. | |||
Specific steps of management: | |||
* Within 1 hour | |||
** Obtain two sets of [[Blood culture|blood cultures]] | |||
** Measure [[lactate]] and the other components of SOFA | |||
** [[Broad-spectrum antibiotics]] | |||
* Initial resuscitation with [[crystalloid]], at least 30 mL/kg in the first 3 hours | |||
** If insufficient, use [[vasopressor]] ([[norepinephrine]] is first choice) | |||
** If insufficient, use [[hydrocortisone]] | |||
* As soon as possible and if necessary | |||
** Source control in case of localized infection | |||
*** Drainage of infection, necrectomy, etc | |||
** Blood products | |||
*** RBCs in case of Hb < 7,0 g/dL or acute bleeding | |||
*** Thrombocytes in case of thrombocytopaenia | |||
** Glucose control | |||
** Early enteral feeding | |||
** Sedation – not too deep. Preferably in an arousable state | |||
** Lung-protective ventilation | |||
** Urinary catheterisation | |||
** Bicarbonate in case of severe metabolic acidosis | |||
** Organ support | |||
*** [[ECMO]] | |||
*** [[Renal replacement therapy]] | |||
* Prophylaxis for | |||
** [[Venous thromboembolism]] ([[UFH]] or [[LMWH]]) | |||
** Stress [[Peptic ulcer disease|ulcer]] ([[PPI]]) | |||
<section end="pathophysiology" /> | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Pathology]] | [[Category:Pathology]] | ||