sepsis 31st jan modified
TRANSCRIPT
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Sepsis: Pathophysiology
and Management in theICU
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Systemic inflammatory response syndromeDiagnostic criteria:
(at least 2 of the following)
1.Temperature >38 C or 90/min
3.Respiratory rate > 20 breaths/min or arterial PCO2 12,000/cmm or 10 % immature
(band) forms
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Definitions
Sepsis : SIRS as a result of infection
Severe Sepsis : Sepsis + dysfunction of 1 or more vital organs
Sepsis Induced Hypotension : SBP
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Determinants of the Sepsis Syndrome
Virulence of the organism
Inoculum of the organism
Site of Infection
Host response
Inflammatory
Anti-inflammatory
Balance
Genetic factors
Susceptibility Regulation
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1)Bacteria-
Aerobes
gram negative rods- klebsiella,serratie
- pseudomonasgram posive cocci - strepto,staph
gram negatiev cocci - meningococci
Mycobacteria
2)Viruses -flavivirus,coronaviridae
3)Rickettsia4) Fungi- candida,histoplasma,aspergillus
Common Etiology
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Pathophysiology
-Loss of hemostatic balance + endothelial dysfunction- Compromising the circulatory system, intracellularhomeostasis.
- Cellular hypoxia and apoptosis .
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Systemicinvolvement
1.Vascular System Micocirculatory shunting dueto:
1)Microthrombi
2)Endothelial cell swelling
narrowing the capillary lumen
3)Activated leukocytesadhering to endothelial cells
4)Dysfunctional RBC
(decreased deformability)
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2.Cardiac dysfunction
Myocardial contractility compromisedDiastolic dilatation of the left ventricle increasing leftventricular end diastolic volume to maintain sufficientstroke volumeRightward shift of frank starling law
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3.Endocrine dysfunction
Corticosteroids-Vasopressin-Insulin-
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Diagnostic criteria for sepsisSSC guidelines 2008
A) Infection, documented or suspected, andsome of the following:
1)General variables : Fever (38.3C), Hypothermia (core temperature 36C),
Heart rate >90 /minor > 2 SD , Tachypnea, Altered mental status, Significant
edema or positivefluid balance (20 mL/kg over 24 hrs), hyperglycemia
(plasma glucose 140
mg/dL or 7.7 mmol/L) in the absence of diabetes
2) Inflammatory variables: Leukocytosis (WBC > 12,000 /L), Leukopenia(WBC