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SIRS, Sepsis, Severe Sepsis, Septic Shock, and MOF. Bryan Imayanagita Trauma Research Associates Program 6/1/12. Systemic Inflammatory Response Syndrome (SIRS). Criteria established in 1992 Related to systemic inflammation, organ dysfunction/failure

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sirs sepsis severe sepsis septic shock and mof

SIRS, Sepsis, Severe Sepsis, Septic Shock, and MOF

Bryan Imayanagita

Trauma Research Associates Program

6/1/12

systemic inflammatory response syndrome sirs
Systemic Inflammatory Response Syndrome (SIRS)
  • Criteria established in 1992
  • Related to systemic inflammation, organ dysfunction/failure
  • Classified as infectious and non infectious
  • Non infectious causes: trauma, burn, pancreatitis, ischemia, hemorrhage, etc
sirs criteria
SIRS Criteria
  • Temp: <36 °C (96.8 °F) or >38 °C (100.4 °F)
  • HR: >90/min
  • RR: >20/min or PaCO2<32 mmHg (4.3 kPa)
  • WBC: <4x109/L (<4000/mm³), >12x109/L (>12,000/mm³)
sepsis
Sepsis
  • SIRS + documented infection
  • Evidence:
    • WBC in sterile fluid (urine, CSF)
    • Perforated viscus
    • Abnormal CXR (pneumonia)
severe sepsis
Severe Sepsis
  • Sepsis associated with organ dysfunction, hypotension, or hypoperfusion abnormalities
    • lactic acidosis
    • Oliguria
    • acute alteration in mental status
  • Can be maintained by IVF
septic shock
Septic Shock
  • Refractory hypotension
  • Significantly decreased tissue profusion
    • Organ failure
    • Ischemia
  • Cannot be maintained by IVF
  • 25-50% mortality
multi organ failure
Multi Organ Failure
  • Homeostasis cant be maintained without intervention
  • 2 or more organ systems
  • Stage 1 the patient has increased volume requirements and mild respiratory alkalosis which is accompanied by oliguria, hyperglycemia and increased insulin requirements.
  • Stage 2 the patient is tachypneic, hypocapnic and hypoxemic. Moderate liver dysfunction and possible hematologic abnormalities.
  • Stage 3 the patient develops shock with azotemia and acid-base disturbances. Significant coagulation abnormalities.
  • Stage 4 the patient is vasopressor dependent and oliguric or anuric. Ischemic colitis and lactic acidosis follow.
treatment
Treatment
  • Antibiotics
  • Early Goal Directed Therapy (EGDT)
    • CVP at 10-12 cm (usually isotonic crystalloid)
    • If MAP <65mm Hg or BP<90  vasopressors/dialators
    • SVO2 optimization by transfusion
    • Monitor urine output
    • Reduced mortality by 16%
treatment cont
Treatment (Cont.)
  • Vasopressors: norepinephrine, dopamine
  • Corticosteroids
    • Most beneficial in septic shock phase or ARDS
prognosis
Prognosis
  • 25-35% severe sepsis and 40-60% of septic shock patients die within 30 days
  • Severity of underlying disease most strongly influences risk of death