Sepsis-3

Question 1

What is the definition of sepsis

Answer 1

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

Question 2

How can organ dysfunction be clincially identified?

Answer 2

SOFA score - sequential organ failure assessment
score of 2 points or more

associated hospital mortality > 10% with 2 or more SOFA score

Question 3

How is septic shock defined

Answer 3

subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone

Question 4

How can patients with septic shock be clinically idenfied?

Answer 4

• requiring vasopressors to maintain MAP of 65 or greater
  AND
• Lactate levels > 2 mmol/L

in the absence of hypovolemia

associated with hospital mortalities > 40%

Question 5

How should the qSOFA score be utilized

Answer 5

• to identify patients in the out-of-hospital, emergency, or general hospital ward setting as being more likely to have a poor outcome typical of sepsis
• prompt clinician to further investigate for organ dysfunction
• initiate or escalate therapy
• consider referred to CC or increase monitoring
• promt consideration for possible infection if not previously recognized

if at least 2 of the following:
* RR >= 22
* GCS < 15 (altered mentation)
* SAP <=100

Question 6

Why are the SIRS criteria not used for sepsis identification anymore?

Answer 6

SIRS is the inflammatory response and SIRS criteria identify therefore a potentially appropriate response to infection

Sepsis by definition involves the inappropriate response involving organ dysfunction, which is not identified by the SIRS criteria

inferior to SOFA to predict hospital mortality in ICU patients with suspected sepsis (outside the ICU SOFA and SIRS are actually similar)