Sepsis and MODS.ppt

Sepsis and MODS Wen-Lin Su, MD, MPH Division of MICU RCC, Department of Critical Care Medicine; Division of Pulmonary Medicine, Department of Medicine. Tri-Service General Hospital, National Defense Medical Center ACCP/SCCM Consensus Conference Definitions Infection= microbial phenomenon characterized by an inflammatory response to the presence of microorganisms or the invasion of normally sterile host tissue by those organisms. Bacteremia = the presence of viable bacteria in the blood. Systemic inflammatory response syndrome (SIRS) The systemic inflammatory response to a variety of severe clinical insults. The response is manifested by two or more of the followings: Temperature 38°C or 36°C Heart rate 90 beats/min Respiratory rate 20 breaths/min or PaCO2 32 mmHg WBC 12,000 cells/mm3, 4000cells/mm3, or 10 % immature (band) forms Sepsis vs Severe Sepsis Sepsis = the systemic response to infection. That is, SIRS with definitive evidence of infection. Severe sepsis = Sepsis associated with organ dysfunction, hypoperfusion, or hypotension. The manifestations of hypoperfusion may include, but are not limited to, lactic acidosis, oliguria, or an acute alteration in mental status. Septic Shock Septic shock = sepsis induced hypotension despite adequate fluid resuscitation along with perfusion abnormalities that may include, but are not limited to, lactic acidosis, oliguria, or an acute alteration in mental status. Patients who are on inotropic or vasopressor agents may not be hypotensive at the time that perfusion abnormalities are measured. Hypotension = systolic BP of 90 mmHg or a reduction of ≧40 mmHg from baseline in the absence of other causes for the fall in blood pressure. * 1 L/hour x 2 hours Definition Multiple Organ Dysfunction Syndrome (MODS/MOF) MODS/MOF = the presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention. Primary MODS = a well-defined insult, occurs early and can be direct