Sepsis and Septic Shock

Question 1

How is sepsis defined?

Answer 1

Life threatening organ dysfunction caused by dysregulated host response to infection

Question 2

How is septic shock defined?

Answer 2

Sepsis along with:

• Persistent hypotension requiring vasopressors to maintain MAP > 65mmHg
• Serum lactate of > 2mmol/L despite adequate volume resuscitation

Question 3

What is the approximate mortality of patients with septic shock?

Answer 3

40%

Question 4

What is the SOFA score? What values does it measure?

Answer 4

• Sequential Organ Failure Assessment, used to predict ICU mortality
• HR, RR, coagulation, LFTs, GCS, renal function

Question 5

What is the qSOFA score? What does it measure?

Answer 5

• quick SOFA, score > 2 suggests longer ICU stay / mortality

1 point for each:

• Altered mental state
• Hypotension, systolic < 100
• Tachypnoea, RR > 22

Question 6

How important is it to administer antibiotics to a patient with septic shock?

Answer 6

For every hour’s delay in administering antibiotics in a patient with septic shock, mortality increases 7.6%

Question 7

What are the body’s main defences against infection?

Answer 7

• Physical barrier: skin, mucosa, epithelial lining
• Innate immune system: IgA in GIT, macrophages etc
• Adaptive immune system: lymphocytes & immunoglobulins

Question 8

What step transitions microbial colonization from just an infection to sepsis?

Answer 8

Organism entering the blood stream

Question 9

What are the three stages in the pathogenesis of sepsis?

Answer 9

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

Question 10

What toxins are commonly released by gram negative and gram positive organisms?

Answer 10

Gram Negative:
- Lipopolysaccharide (LPS)

Gram Positive:

• MAMP (lipoteichoic acid)
• Superantigens (staphylococcal toxic shock syndrome toxin (TSST) / streptococcal exotoxins)

Question 11

What are the two types of mediator response initiated by the body in response to bacterial toxins?

Answer 11

• Th1 response: pro-inflammatory, if excessive causes inflammatory response that characterizes sepsis
• Th2 response: anti-inflammatory, if excessive can cause immunoparalysis

Question 12

How are the mediator responses initiated within the body?

Answer 12

• Bacteria taken up by immune cell (macrophage, neutrophil, dendritic cell)
• Immune cell activates CD4 T cell
• CD4 T cell initiates either Th1 or Th2 response

Question 13

What is a proper immune response characterized by in terms of Th1 and Th2 responses?

Answer 13

A balance between Th1 & Th2

• Excess Th1: inflammation leading to septic shock
• Excess Th2: immunoparalysis (no immune response)

Question 14

What are some general clinical presentations of sepsis?

Answer 14

• Fever or hypothermia
• Tachycardia & Tachypnoea
• Altered mental status (esp. in elderly)
• Hyperglycaemia (> 8mmol/L in a non-diabetic)

Question 15

What are some inflammatory markers of sepsis?

Answer 15

• Leucocytosis (WCC > 12,000/mL)
• Leucopenia (WCC < 4000/mL)
• High CRP
• High procalcitonin

Question 16

What are some possible organ dysfunction signs that can be seen on investigation of sepsis?

Answer 16

• Arterial hypoxaemia
• Oliguria
• Increased creatinine
• Coagulation abnormalities
• Ileus (backup of intestinal material)
• Thrombocytopenia
• Hyperbilirubinaemia

Question 17

What are the Sepsis 6?

Answer 17

Take 3, Give 3:

Take:
- Blood culture, Blood Lactate, Measure urine output

Give:
- Oxygen (aim sats 94-98%), IV antibiotics, IV fluid

Question 18

What is the purpose of the sepsis 6?

Answer 18

• Reduce mortality by providing vital support

- Get a better idea of the effect the sepsis is having on the patient