Sepsis & Septic Shock

Last Updated on October 23, 2022

Definition / Introduction

📌 Sepsis = life-threatening organ dysfunction caused by dysregulated host response to infection

📌 Septic shock= sepsis that has circulatory, cellular and metabolic abnormalities that are associated with a greater risk of mortality than sepsis alone

📌 Hypoperfusion= ≥1 of the following after administration of ≥30 mL/kg IV fluid OR serum lactate >4 mmol/L::
(i) SBP <90 mmHg
(ii) MAP <65 mmHg
(iii) SBP fall >40 mmHg from usual baseline

Criteria

Systemic inflammatory response syndrome (SIRS)

Any 2 of the criteria are met:

• Body temperature >38 °C / <36 °C
• HR >90 bpm
• RR >20 OR pCO2 <32 mmHg
• Leucocyte >12 or <4 x10⁹/L

Notes:
However, remember that almost all septic patients have SIRS, but not all SIRS patients are septic

Quick SOFA (qSOFA)

Any 2 of the criteria below are met:

• RR >22
• Altered mental status
• SBP ≤100 mmHg

Notes:
• Score of ≥2 suggests greater risk of poor outcome
• Score of ≥2 indicates for ICU referral
• Mnemonic: RAS

Management

Surviving sepsis campaign 2019

HOUR-1 BUNDLE: INITIAL RESUSCITATION FOR SEPSIS AND SEPTIC SHOCK:
1) Measure initial lactate level
2) Blood C&S
3) Broad spectrum antibiotics
4) Rapid administration of crystalloid for hypotension / serum lactate >4 mmol/L
5) Vasopressor if hypotensive during / after fluid resuscitation. Maintain MAP >65 mmHg
6) Re-measure serum lactate if initial level >2 mmol/L

Q&A

Reference

1. Kumar and Clarks Clinical Medicine 9th ed