Week 7 , Lecture C - Sepsis

Question 1

What is SIRS

Answer 1

Clinical response arising from
nonspecific insult, including
2 or more of the following:

• Temperature =/>38oC or 90 beats/min
• Respirations =/>20/min
• WBC count =/> 12,000/mm3 or
4,000/mm3 or less than or >10% immature
neutrophils

Question 2

What is sepsis

Answer 2

SIRS with a presumed
or confirmed
infectious process

Question 3

What is severe sepsis?

Answer 3

Sepsis with 1 or more sign of organ
failure
Cardiovascular (refractory
hypotension)
Renal
Respiratory
Hepatic
Hematologic
CNS
Metabolic acidosis

Question 4

Incidence and mortality for septic shock

Answer 4

Rare but death rate is 50%

Question 5

Where can patients with sepsis come from?

Answer 5

Community and be admitted to ward or icu

or
may develop it while in hospital or ICU, especially if develops pneumonia

Question 6

What is the management of septic shock?

Answer 6

 Early recognition
 Early haemodynamic resuscitation and continued
support
 Early and adequate antibiotic therapy
 Source control
 Tight glycaemic control
 Protective mechanical ventilation

Question 7

Effect of infection on muscles

Answer 7

pro-inflammatory cytokines > intracellular mediators > catabolism or dysfunction > breaking down of muscle mass

Question 8

Effect of immobilsation on muscles

Answer 8

 Muscles - not inactive partners
during immobility - work in
bidirectional role to
inflammatory signalling
 Proinflammatory state develops
with bed rest, with ­
production of reactive oxygen
species (ROS), and ¯ in antioxidative
defences
 Immobile muscles therefore
cause even more acute as well
as long term deleterious effects
to patient.

Question 9

Why exercising ICU patient is good for their muscles

Answer 9

Exercise training - been shown to ¯ the local expression of
cytokines & inducible nitric oxide synthase (iNOS)
in muscle biopsies of CHF patients

Question 10

Barriers to exercise in early stage septic shock

Answer 10

 Cardiovascular
instability
 High vasopressor
requirement
 Vasodilatation ie vasoplegic
 Respiratory instability
 Nitric oxide
 Invasive lines ++
 Heavy sedation
 Equipment ++

Question 11

preliminary evidence early stage septic shock

Answer 11

Passive stretch = increased cognititon, decreased delirium, decreased length of stay

Question 12

How can physio affect the prognosis of someone with sepsis

Answer 12

 We can make a difference in weakness
post ICU in sepsis by:
 Early passive exercise
 EMA
 Sitting on edge of bed
 Sitting up high
 Active assisted X’s as soon as able
 Early walking with equipment