Sepsis and Septic Shock Flashcards
what is the definition of sepsis?
- Sepsis derives from the Greek work “sepo” meaning decay or decomposition
- Systemic illness caused by microbial invasion of normally sterile parts of the body
what are the different types of sepsis?
systemic inflammatory response syndrome - SIRS is a serious condition related to systemic inflammation, organ dysfunction, and organ failure. It is a subset of cytokine storm, in which there is abnormal regulation of various cytokines. SIRS is also closely related to sepsis, in which patients satisfy criteria for SIRS and have a suspected or proven infection
can you have infection and SIRS?
You can have infection, SIRS or both
what is the proper definition of sepsis?
Sepsis is defined as life-threatening organ dysfunction caused by dysregulated host response to infection
- Organ dysfunction can be identified as an acute change in total SOFA score >2 points consequent to the infection
- SOFA score >2 reflects an overall mortality risk of approximately 10% in a general hospital population with suspected infection
Patients with suspected infection who are likely to have a prolonged ICU stay or die in the hospital can be promptly identified with a qSOFA. Not used to diagnose but used to say what patients are likely to have a poorer outcome and higher mortality
what is septic shock?
Septic shock can be identified with a clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP >65mmHg and having a serum lactate of >2mmol/l despite adequate volume resuscitation
Patients with septic shock have a hospital mortality of 40%
why is sepsis so important?
- Common condition
- Becoming more common
- Increased morbidity
- Increased mortality
what is the length of stay like in a patient with sepsis compared to other conditions?
what is the survival in septic shock based on?
Survival in septic shock based on antimicrobial delay
For each hours delay in administering antibiotics in septic shock, mortality increases by 7.6%
can we make a difference?
- There are interventions proven to reduce mortality and cost
- However, these interventions are not routinely done in all settings
- Myocardial infarction: Time is muscle
- Stroke: Time is brain
- Sepsis: Time is ____
life
what are the bodys defences against sepsis?
- Physical barrier - skin, mucosa, epithelial lining
- Innate immune system - IgA in gastrointestinal tract, dendritic cells/macrophages
- Adaptive immune system - lymphocytes, immunoglobulins
what is the origin of sepsis?
- Originates from a breach of integrity of host barrier, whether physical or immunological
- Organism enters the bloodstream creating a septic state
what is the pathophysiology of sepsis?
Uncontrolled inflammatory response
Patients with sepsis have features consistent with immunosuppression:
- Loss of delayed hypersensitivity
- Inability to clear infection
- Predisposition to nosocomial infection (originating in hospital)
Probable change of the sepsis syndrome over time:
- Initially there is an increase in inflammatory mediators
- Later, there is a shift toward an anti-inflammatory immunosuppressive phase
- Depends on the health of the individual patient
What are the three phases in the pathogenesis of sepsis?
- Release of bacterial toxins
- Release of mediators
- Effects of specific excessive mediators
WHat happens in Phase 1: Release of bacterial toxins?
- Bacterial invasion into body tissues is a source of dangerous toxins
- May or may not be neutralised and cleared by existing immune system
Gram negative and positive release different toxins
what toxins are released by gram negative?
Lipopolysaccharide (LPS)
what toxins are released by gram positive
• Microbial-associated molecular pattern (MAMP):
- Lipoteichoic acid
- Muramyl dipeptides
• Superantigens:
- Staphylococcal toxic shock syndrome toxin (TSST)
- Streptococcal exotoxins
What happens in Phase 2: Release of mediators in response to infection?
- Effects of infections due to endotoxin release
- Effects of infections due to exotoxin release
- Mediator role on sepsis
what is involved in endotoxin release?
- LPS needs an LPS-binding protein to bind to macrophages
- LTA do not need such proteins
what is involved in exotoxin release?
- Pro-inflammatory response
- Small amounts of superantigens will cause a large amount of mediators to be secreted: cascade effect
What is the mediator role in sepsis (Th1 vs Th2)?
- Two types of mediators can be released
- Pro-inflammatory mediators - causes inflammatory response that characterises sepsis
- Compensatory anti-inflammatory reaction - can cause immunoparalysis
what do you need to happen between the 2 different immune responses?
Balance between the various immune responses
What happens if there is more of a pro-inflammatory repsonse than an anti-inflammatory repsonse?
Septic shock with multiorgan failure and death
What happens if there is more of an anti-inflammatory repsonse than a pro-inflammatory response?
Immunoparalysis with uncontrolled infection and multiorgan failure
How does the bodies immune system react in sepsis?
Healthy – as soon as infected their body produces an inflammatory response
what organ dysfunction can sepsis cause?
what is the management process of suspeted sepsis
what is sepsis 6 2 As, 2 Bs, 2 Cs?
Case 2:
- 68 year old woman admitted with worsening shortness of breath
- History of IHD, CVA and bed bound
- On examination: Alert, Temp 38oC, Resp rate 26/min, pulse 120/min irreg, BP 85/60, Chest dullness right base
- qSOFA =
2
Case 2:
- What is your working diagnosis?
- How would you make a diagnosis?
- What score will you use?
What should be done in the next 60 minutes?
- Oxygen
- IV fluid challenge
- Blood cultures
- Blood lactate
- IV Antibiotics
- Monitor urine output
