Identifying Severe Sepsis
Signs and symptoms of severe sepsis may be subtle. The unacceptably low survival rate of patients with sepsis indicates that current patient identification strategies may be lacking.
Identifying patients with severe sepsis early and correcting the underlying microvascular dysfunction may improve patient outcomes. If not corrected, microvascular dysfunction leads to global tissue hypoxia and direct tissue damage. This ultimately results in organ failure and often death.1-4
Clinical manifestation of severe sepsis
Sepsis is defined as systemic inflammatory response syndrome (SIRS) resulting from infection (bacterial, viral, fungal, or parasitic).
The increasing severity and mortality of sepsis is illustrated by a continuum of events:
- Severe sepsis
- Septic shock
- Multiple organ dysfunction syndrome (MODS), which often results in death
Systemic inflammatory response syndrome (SIRS)
SIRS is a reference for the complex findings that result from a systemic activation of the innate immune response, regardless of cause.5 SIRS includes the presence of more than one of the following manifestations:6
- Temperature ≥100.4°F or ≤96.8°F (≥38°C or ≤36°C)
- Heart rate ≥90 beats/min.
- Tachypnea, as manifested by a respiratory rate ≥20 breaths/min. or hyperventilation, as indicated by a PaCO2 ≤32 mmHg
- Alteration of white blood cell count ≥12,000 cells/mm3, ≤4,000 cells/mm3, or the presence of >10% immature neutrophils
Sepsis
Sepsis is defined by the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) as SIRS resulting from infection (bacterial, viral, fungal, or parasitic).
Severe sepsis
Severe sepsis is sepsis associated with at least one acute organ dysfunction, hypoperfusion, or hypotension.
Septic shock
Septic shock occurs when sepsis-induced hypotension persists despite adequate fluid resuscitation.5
Multiple organ dysfunction syndrome (MODS)
MODS is characterized by the presence of altered function of two or more organs in an acutely ill patient, such that homeostasis cannot be maintained without intervention.
References:
- Aird WC. The role of the endothelium in severe sepsis and multiple organ dysfunction syndrome. Blood. 2003;101(10):3765-3777.
- Beal AL, Cerra FB. Multiple organ failure syndrome in the 1990s. Systemic inflammatory response and organ dysfunction. JAMA. 1994;271(3):226-233.
- McCuskey RS, Urbaschek R, Urbaschek B. The microcirculation during endotoxemia. Cardiovasc Res. 1996;32(4):752-763.
- Papathanassoglou ED, Moynihan JA, Ackerman MH. Does programmed cell death (apoptosis) play a role in the development of multiple organ dysfunction in critically ill patients? Crit Care Med. 2000;28(2):537-549.
- Bone RC. Toward an epidemiology and natural history of SIRS (systemic inflammatory response syndrome). JAMA. 1992;268(24):3452-3455.
- Bernard GR, Vincent JL, Laterre PF, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 2001;344(10):699-709.
