Sepsis in the ICU

Sepsis in the ICU is a topic covered in the Pocket ICU Management.

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First Things First (assess & treat for the following)

  • IF A PT IS IN SHOCK, RESUSCITATE & SUSTAIN THE ABCs FIRST, THEN ASCERTAIN THE ETIOLOGY AFTER TREATMENT IS INITIATED!
  • Sepsis is the leading cause of death in noncardiac ICUs.
  • Speed and appropriateness of therapy administered in the initial hours after severe sepsis are likely to influence outcome.
  • Does the patient have sepsis?
    • Systemic inflammatory response syndrome (SIRS) criteria
    • SIRS: two or more criteria
      • Temperature >38C or < 36C
      • Heart rate >90 beats/min
      • Respiratory rate >20 breaths/min or PaCO2 < 32 mmHg
      • WBC >12,000 or < 4,000 cells/mm3 or >10% immature forms (bands)
    • Sepsis: SIRS secondary to documented or suspected infection
  • Does the patient have severe sepsis?
    • Severe sepsis: acute organ dysfunction secondary to infection or tissue hypoperfusion
      • Sepsis-induced hypotension:
      • SBP < 90 mmHg
      • Reduction of SBP of >40 mmHg in adults
      • Mean arterial pressure < 70 mmHg
      • Perfusion abnormalities present
      • Elevated lactate greater than upper limits of normal
      • Elevated creatinine >2.0 mg/dl
      • Bilirubin >2 mg/dl
      • Platelet count < 100,000/mm3
      • Coagulopathy (INR >1.5)
      • Urine output < 0.5 mL/kg hr for >2 hrs, despite fluid resuscitation
      • Acute lung injury (ALI) with PaO2/FiO2 < 250 in the absence of pneumonia as infection source
      • ALI with PaO2/FiO2 < 200 in the presence of pneumonia as infection source
      • Altered mental status
  • Does the patient have septic shock?
    • Septic shock: severe sepsis plus hypotension not reversed with fluid resuscitation
  • Consider noninfectious causes of SIRS.
    • Differential diagnosis
      • MI, PE, pancreatitis, anaphylactic reaction, toxic shock syndrome, drug overdose or poisoning, hypothermia, delirium tremens, transfusion reaction, cardiac tamponade, UGI bleed, acute adrenal insufficiency

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Last updated: June 15, 2010

Citation

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TY - ELEC T1 - Sepsis in the ICU ID - 534027 Y1 - 2010/06/15/ BT - Pocket ICU Management UR - https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534027/all/Sepsis_in_the_ICU PB - PocketMedicine.com, Inc DB - Anesthesia Central DP - Unbound Medicine ER -