UPDATE ON SEPSIS

THE THIRD INTERNATIONAL CONSENSUS

DEFINITIONS FOR SEPSIS AND SEPTIC
SHOCK FEBRUARY 2016

GEZY WEITA,DR
Key Concept of Sepsis

Sepsis is the primary cause of death due to infection

Early recognition and treatment is key to survival

Sepsis must be considered in any patient presenting with an

infection

Depending on pathogen and host factor multifaceted depending on

prexisting acute ilness, coex, treatments and drugs
Reality Check

1. The last sepsis definition conference 2001 --> sepsis

pathobiology has improved during the last 20 years

2. Strong correlation between infection, host and treatment

each patient individualized sepsis picture

3. What differentiate sepsis from infection is a dysregulated

host response and presence of organ dysfunction

4. SIRS is not Sepsis

Basic Sepsis Concept 2016

Sepsis is a life threatening condition

when the bodys response to infection
injures itself
Severe sepsis no longer exists only

sepsis and septic shock

Sepsis New Terms And Definitons

Sepsis is defined as a life threatening organ

dysfunction caused by a dysregulated host response
to infection
Organ dysfunction acute change in total SOFA
score 2 points prior to infection (baseline sofa is
considered 0 in patient without preexisting organ
dysfunction)
Patients with suspected infection who are likely to
die or have a prolonged ICU stay can be monitored
with quick SOFA (q-SOFA)
QUICK SOFA (Q-SOFA)

Altered Mental
Status

Respiratory
Systolic BP
Rate 22
100 mmHg
x/min
SEPTIC SHOCK

NOT a cardiovascular disease alone but a celluler

disease

Septic Shock persisting hypotension requiring

vasopressors to maintain MAP 65 mmHg AND

having a serum lactate > 2 mmol/L despite adequate

volume resuscitation
Controversies and Limitations

Failure to meet the q SOFA or SOFA should stop

further investigations
If q SOFA is assessed further lab test to identify
biochemical organ dysfunction
SIRS criteria may still remain useful
Lactate should not be added to identify sepsis but its
use should not be limited either
 Clinical Operationalization of New Sepsis Criteria

Patient with suspected infection ?

Monitor clinical condition and
reevaluate for possible sepsis sepsis is
qSOFA ? (See A) Sepsis still suspected clinically indicated

Assess for evidence of organ dysfunction

SOFA 2 ? ( see B )

Monitor clinical condition and reevaluate for possible sepsis

SEPSIS sepsis is clinically indicated

Despite adequate fluid resuscitation Vasopressors required to maintain MAP 65 mmHg

AND serum lactate > 2 mmol/L

SEPTIC SHOCK
Take Home Message

Early recognition of sepsis in all infection is crucial for

future morbidity and mortality

Bed site and clinical assessment is important

Lab examination could be as complicated or as simple as

the possible local facilitiation

Future studies are supposed to be done on sepsis