SIRS and Sepsis – Definitions and Pearls

SIRS/Sepsis
New definition of sepsis, new bedside screen to identify patients at high-mortality risk

Clinical Question:
What are the best criteria to
identify sepsis and septic shock?

Bottom Line:
An international task force of experts has updated the definitions of sepsis and septic shock and
created a new bedside scoring tool to identify patients with suspected
infection who may be at high risk for poor outcomes. Based on the
Sequential Organ Failure Assessment (SOFA) score, the new quickSOFA states
that meeting 2 of 3 clinical criteria:

– respiratory rate of 22 per minute or greater,
– systolic blood pressure of 100 mg Hg or less,
– altered mental status
identifies patients at high risk of poor outcomes from sepsis. This
score will need to be validated further in multiple health care settings
before it can be widely accepted in clinical practice. (LOE = 5)
Reference:
Singer M, Deutschman CS, Seymour CW, et al. The third
international consensus definitions for sepsis and septic shock (Sepsis-3).
JAMA 2016;315(8):801-810.

Seymour CW, Liu VX, Iwashyna TJ, et al.
Assessment of clinical criteria for sepsis (Sepsis-3). JAMA
2016;315(8):762-774.

—————————————
SIRS – 2 of 4 = sepsis  // Sepsis – SIRS+infect // Severe – sepsis + end-organ // Shock – still hypotension despite IVF
Temperature <36, >38
Heart rate >90
Respiratory rate >20/min or PaCO2 < 32
WBC < 4, >12, > 10% bands
 
qSOFA – 2 of 3 = sepsis
Resp rate >22/min
Altered mentation
SBP <100
 
Criteria to transfer to ICU:
-Temp: >38.3 or <36
-worsening trend in any vital signs
-HR >90 despite fluid boluses
-SBP <90 despite fluid boluses
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