Sepsis / 敗血症. Sang-Oh Lee Div. of Infectious Diseases Gil Medical Center Gachon Medical School. Systemic Response to Stimuli. When in a fever not of the intermittent type dyspnoea and delerium come on, the case is mortal. Hippocrates (the 5 th century BC ).
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Div. of Infectious Diseases
Gil Medical Center
Gachon Medical School
When in a fever not of the intermittent type dyspnoea and delerium come on, the case is mortal.
Hippocrates (the 5th century BC )
already in progress
clinical evidence of infection
rectal temperature > 101 °F or < 96 °F
tachycardia (> 90/min) / tachypnea (> 20/min)
at least one of inadequate organ functions
mental change / hypoxemia / oligouria /
Bone RC. Crit Care Med 17:389-93, 1989
Chest 101:1644-55, 1992
temperature > 38 °C or < 36 °C
tachycardia (> 90/min)
tachypnea (> 20/min) or PaO2 < 32 mmHg
WBC > 12,000/mm3, < 4,000/mm3, or
> 10% immature forms
two or more of criteria !
2,527 Cases of SIRS
JAMA 273:117-23, 1995
Sepsis + organ hypoperfusion or hypotension
(including but not limited to lactic acidosis,
oligouria, or mental change)
sBP < 90 mmHg or > 40 from baseline
despite adequate fluid resuscitation
That means just a severe patient !
High sensitivity, but too low specificity !
No account of site or type of infection !
Vincent JL. Crit Care Med 25:372-4, 1997
and helpful at the bedside !
account of pathophysiology & organisms
Dellinger RP, Bone RC. Crit Care Med 26:178-9, 1998
necessary but not sufficient
fluid resuscitation with CVP monitor !!!
vasoconstrictors & inotropics
Cardiac Index > 4 L/min/m2
> 6 ug/kg/min
Vasodilation – SVR
Nep / Phenylephrine / Epi
respiratory compensation by ventilator