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Sepsis is an important diagnosis in the critical care unit. This chapter will discuss its definition, pathogenesis, early goal directed therapy, and types of infection.


Systemic inflammatory responses (SIRS) is defined as more than 2 of the following: temperature less than 36°C or greater than 38°C, heart rate (HR) greater than 90 beats/min, respiratory rate (RR) greater than 20 breaths/min, PaCO2 less than 32 mmHg, white blood cell (WBC) count less than 4000 per mm3 or more than 12,000 per mm3, or greater than 10% immature bands.1 Systemic inflammatory responses associated with infection have been the definition of sepsis for 2 decades. Sepsis with organ dysfunction has been the definition of severe sepsis. Septic shock has been the definition of hypotension despite adequate fluid resuscitation requiring vasopressors and attributed to sepsis.

Improved understanding of this syndrome and the need for uniformity prompted a reevaluation of the criteria. From the Third International Surviving Sepsis Guidelines, the definition of sepsis is defined as life-threatening organ dysfunction by a dysregulated host response to infection.2,3 Organ dysfunction is defined as an acute change of 2 points or more in total Sequential Organ Failure Assessment (SOFA) score secondary to infection.2,3 Mortality is 10%. A bedside SOFA or quick SOFA (qSOFA) consists of RR of 22 or more per minute, altered mental status, and systolic blood pressure (SBP) of 100 mmHg or less. The full SOFA score is in Table 18-1.4

TABLE 18-1Sequential (Sepsis-Related) Organ Failure Assessment Scorea

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