Esquema Sepsis

Esquema Segundo parcial

Ana Natalia Prior Nava Patología Quirúrgica ( 11933 ) Dr. Jorge Luis De León Rendón Universidad Anáhuac México

Definition

Definition

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

Elements & Characteristics

Septic Shock

Sepsis

Diagnosis

Diagnosis

Recommendations

Recommendations

Organ Dysfunction

Diagnosis

Definition

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It is a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. The hospital mortality rates greater than 40%. -Septic Shock should reflect a more severe illness with a much higher likelihood of death than sepsis alone.

It is represented by an increase in the Sequential Organ Failure Assessment (SOFA) = score of 2 points or more, which is associated with an in-hospital mortality greater than 10%. -A higher SOFA score is associated with an increased probability of mortality. +The score grades abnormality by organ system and accounts for clinical interventions. +Laboratories are also needed:

• PaO2
• Platelet count
• Creatinine level
• Bilirubin level

It is a life-threatening organ dysfunction caused by a dysregulated host response to infection. It is clysify as a syndrome of physiologic, pathologic, and biochemical abnormalities induced by infection. Sepsis is a multifaceted host response (nonhomeostatic) to an infecting pathogen that may be significantly amplified by endogenous factors. -It is a major public health concern and a leading cause of mortality and critical illness worldwide.

Criteria

• Hypotension: arterial pressure less than 65mm/Hg.
• Vasopressor therapy requirement to maintain a mean arterial pressure of 65 mm/Hg or greater.

• Serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia.

Elevated lactate level is reflective of cellular dysfunction in sepsis; hyperlactatemia is, however, a reasonable marker of illness severity, with higher levels, predictive of higher mortality. quickSOFA (qSOFA):

• respiratory rate of 22/min or greater.
• altered mentation.
• systolic blood pressure of 100 mm/Hg or less.

The task force suggests that qSOFA criteria be used to prompt clinicians to further investigate for organ dysfunction, to initiate or escalate therapy as appropriate, and to consider referral to critical care or increase the frequency of monitoring; positive qSOFA criteria should also prompt consideration of possible infection in patients not previously recognized as infected.

• Early recognition is particularly important because prompt management of septic patients may improve outcomes.

• The potential lethality is considerably in excess of a straightforward infection.

• Even a modest degree of organ dysfunction when infection is first suspected is associated with an in-hospital mortality in excess of 10%.
• Widespread educational campaigns are recommended to better inform the public about this lethal condition.

Elements of sepsis

• infection
• host response
• organ dysfunction

-Cellular defects underlie physiologic and biochemical abnormalities within specific organ systems. It involves early activation of both pro- and anti-inflammatory responses, along with major modifications in nonimmunologic pathways, such as cardiovascular, neuronal, metabolic and coagulation; all of which have a prognostic significance. Sepsis involves organ dysfunction, indicating a pathobiology more complex than infection, plus an accompanying inflammatory response alone.

Multiple organ dysfunction syndrome (MODS) refers to the critical illness characterized by reversible physiological abnormalities with the dysfunction of two or more organs that occurs simultaneously, leading to longer stays in the intensive care unit (ICU) and, in severe conditions, results in higher mortality. It is recognized as a critical condition that necessitates extensive clinical management and requires huge healthcare resources. Therefore, identifying the potential preventable predisposing factors in high-risk patients can be favorable for decreasing mortality. *It´s not associated with substantial cell death.

For hospital use, there are 2 scales that helps a presumptive diagnosis:

• Logistic Organ Dysfunction System
• SOFA

SOFA is better known and simpler than the Logistic Organ Dysfunction System. Baseline SOFA score should be assumed to be zero, unless the patient is known to have preexisting organ dysfunction before the onset of infection. Depending on a patient’s baseline level of risk, a SOFA score of 2 or greater, increases risk of dying, compared with patients with a SOFA score less than 2. *Score is not intended to be used as a tool for patient management, but as to clinically characterize a septic patient. qSOFA (quick SOFA) was newly developed and incorporated. This evaluates:

• altered mentation.
• systolic blood pressure of 100 mm/Hg or less.
• respiratory rate of 22/min or greater.

It provides simple bedside criteria to identify adult patients with suspected infection who are likely to have poor outcomes. This simple bedside score may be particularly relevant in resource-poor settings, in which laboratory data are not readily available, and when the literature about sepsis epidemiology is sparse.

• Adequate fluid resuscitation.
• Early recognition and treatment.

The combination of hypotension, vasopressor use, and lactate level greater than 2 mmol/L (18 mg/dL) identified patients with mortality rates of 54%, because the combination encompasses cellular dysfunction and cardiovascular compromise.