Sepsis_Pathophysiology and Treatment

Posted by e-Medical PPT
Systemic Inflammatory Response Syndrome (SIRS) :
Systemic inflammatory response to various stresses.
Meets 2 or more of the following criteria :
 Temperature of >38C/<36degree C
 Heart rate of more than 90 beats/min
 RR >20 breaths/min or PaCo2 <32mmHg
 WBC >12,000/mm3 or <4000/mm3

Evidence of SIRS accompanied by known or suspected infection.

Severe SEPSIS :
Sepsis accompanied by hypoperfusion or organ dysfunction.
Cardiovascular :
SBP<90mmhg/MAP<70 for at least 1 hr despite adequate volume resuscitation or the use of vasopressors to achieve the same goals.
Renal :
Urine output <0.5ml/kg/hr or Acute Renal Failure.
Pulmonary :
PaO2/FiO2 <250if other organ dysfuncton is present or <200 if the lungs is the only dysfunctional organ.
Gastrointestinal :
Hepatic dysfunction (hyperbilirubinemia,Elevated transaminases
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 >5.0mmol/L
Plasma lactate >1.5  upper limit of normal.

Septic Shock :
Severe Sepsis with persistent hypoperfusion or hypotension despite adequate fluid resuscitation

Multiple Organ Dysfunction Syndrome (MODS)
MODS occurs late and is the most common cause of death in patients with Sepsis.
Lactic acidosis led investigators to think that this is due to tissue ischaemia.
Minimal cell death in postmortem samples taken from the failed organs of patients with Sepsis.
Recovery from Sepsis is associated with near complete recovery of organ function, even in organs whose cells have poor regenerative capacity.
Increased tissue oxygen tensions in various organs (muscle, gut, bladder) in animals and patients with Sepsis.

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