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6 - Sepsis and Septic Shock

from Section 2 - Infectious Disease Emergencies

Published online by Cambridge University Press:  02 November 2023

By
Erica Chimelski
Edited by
Kaushal Shah  and
Jarone Lee
Edited in association with
Clark G. Owyang  and
Benjamin Christian Renne
Kaushal Shah
Affiliation:
Weill Cornell Medical Center, New York
Jarone Lee
Affiliation:
Massachusetts General Hospital, Boston
Clark G. Owyang
Affiliation:
Weill Cornell Medical Center, New York
Benjamin Christian Renne
Affiliation:
Massachusetts General Hospital, Boston
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Summary

  • Sepsis is currently defined as life-threatening organ dysfunction caused by dysregulated host response to infection. Septic shock is sepsis with persistent hypotension requiring vasopressor to maintain mean arterial pressure (MAP) ≥ 65 mmHg and having a serum lactate > 2 mmol/dL despite adequate fluid resuscitation.

There is wide variation in test characteristics for screening scores such as systemic inflammatory response syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS). A qSOFA score of ≥ 2 or a change in SOFA score of ≥ 2 can promptly identify these patients; however, qSOFA is not recommended as a single screening tool over comparable scores such as SIRS, NEWS, or MEWS.

Keywords

sepsisseptic shockinfectionhypotensionantimicrobial therapycritical care
Type
Chapter
Information
Practical Emergency Resuscitation and Critical Care , pp. 58 - 62
Publisher: Cambridge University Press
Print publication year: 2023

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References

ARISE Investigators, ANZICS Clinical Trials Group, Peake, SL, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med 2014; 371:1496–1506.Google ScholarPubMed
Evans, L, Rhodes, A, Alhazzani, W, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021;47(11):1181–1247. https://doi.org/10.1007/s00134-021-06506-yCrossRefGoogle ScholarPubMed
ProCESS Investigators, Yealy, DM, Kellum, JA, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med 2014;370:1683–1693.Google ScholarPubMed
ProMISe Investigators, Mouncey, PR, Osborn, TM, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med 2015;372:1301–1311.CrossRefGoogle ScholarPubMed
Rhodes, A, Evans, LE, Alhazzani, W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med 2017;45:486–552.CrossRefGoogle ScholarPubMed
Rivers, E, Nguyen, B, Havstad, S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368–1377.CrossRefGoogle ScholarPubMed
Singer, M, Deutschman, CS, Seymour, CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315:801–810.CrossRefGoogle ScholarPubMed

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