Sepsis in the ICU
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
- Severe sepsis: acute organ dysfunction secondary to infection or tissue hypoperfusion
- 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
- Differential diagnosis
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Last updated: June 15, 2010
Citation
"Sepsis in the ICU." Pocket ICU Management, PocketMedicine.com, Inc, 2010. Anesthesia Central, anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534027/all/Sepsis_in_the_ICU.
Sepsis in the ICU. Pocket ICU Management. PocketMedicine.com, Inc; 2010. https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534027/all/Sepsis_in_the_ICU. Accessed October 10, 2024.
Sepsis in the ICU. (2010). In Pocket ICU Management. PocketMedicine.com, Inc. https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534027/all/Sepsis_in_the_ICU
Sepsis in the ICU [Internet]. In: Pocket ICU Management. PocketMedicine.com, Inc; 2010. [cited 2024 October 10]. Available from: https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534027/all/Sepsis_in_the_ICU.
* Article titles in AMA citation format should be in sentence-case
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T1 - Sepsis in the ICU
ID - 534027
Y1 - 2010/06/15/
BT - Pocket ICU Management
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PB - PocketMedicine.com, Inc
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