Lecture 6 Sepsis and Septic Shock

Question 1

What is the traditional model of sepsis

Answer 1

SIRS
Sepsis (SIRS and infection)
Severe Sepsis (Sepsis and end organ damage)
Septic Shock (Severe Sepsis and Hypotension)

Question 2

Define sepsis

Answer 2

: life-threatening organ dysfunction caused by dysregulated host response to infection

Question 3

Define Sepsis shock

Answer 3

Sepsis with persistent hypotension requiring vasopressors to maintain MAP >65mmHg

Question 4

Clinical features of sepsis

Answer 4

• Hypotension systolic BP <100mmHg
• Altered mental status
• Tachypnoea RR>22/min

Question 5

What are the three phases in the pathogenesis of sepsis

Answer 5

1. Release of bacterial toxins
2. Release of mediators
3. Effects of specific excessive mediators

Question 6

What are commonly released gram negative toxins

Answer 6

LPS

Question 7

What are commonly released gram positive toxins

Answer 7

MAMP and superantigens

Question 8

What are exotoxins

Answer 8

Proteins produced inside pathogenic bacteria

Question 9

What are endotoxins

Answer 9

Are lipid portions of LPS that are part of the outer membrane of the cell wall of gram-negative bacteria

Question 10

What are the effects of pro-inflammatory mediators

Answer 10

Cause inflammatory response that characterises sepsis
o Promote endothelial cell-leukocyte adhesion
o Release arachidonic metabolites
o Complement activation
o Vasodilation of blood vessels by NO
o Increase coagulation by release of tissue factors and membrane coagulants
o Cause hyperthermia

Question 11

What are the effects of anti-inflammatory reaction

Answer 11

Immunoparalysis
o Inhibit TNF alpha
o Augment acute phase reaction
o Inhibit activation of coagulation system

Question 12

What are the general features of Sepsis

Answer 12

• Fever >30C- presenting as chills, rigors, flushes, cold sweats, night sweats etc.
• Hypothermia <36C- especially in the elderly and very young children (immunosuppressed)
• Tachycardia >90 beats/min
• Tachypnoea >20/min
• Altered mental state- especially in elderly
• Hyperglycaemia >8mmol/l in the absence of diabetes

Question 13

Name inflammatory variables in sepsis

Answer 13

• Leucocytosis (WCC>12,000/ml)
• Leukopenia (WCC<4,00/ml)
• Normal WCC with greater than 10% immature forms
• High CRP
• High procalcitonin

Question 14

Name organ dysfunction variables in spesis

Answer 14

• Arterial hypoxaemia
• Oliguria
• Creatinine increase compared to baseline
• Coagulation abnormalities
• Ileus
• Thrombocytopenia
• Hyperbilirubinemia

Question 15

Name tissue perfusion variables in sepsis

Answer 15

• High lactate

* Skin mottling and reduced capillary perfusion

Question 16

What is Sepsis 6

Answer 16

Take 3 Give 3
Blood cultures
Blood lactate
Measure urine output

Give:
Oxygen aim sats 94%-98%
IV antibiotics
IV fluid challenge

Question 17

When to consider ITU

Answer 17

• Septic shock
• Multi-organ failure
• Requires sedation, intubation and ventilation