Sepsis Redefined

New recommendations for sepsis was published in the February 2016 issue of JAMA and highlighted at SCCMs 45th Critical Care Congress in Orlando, Florida.

Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection.  Septic shock is defined as a subset of sepsis in which profound circulatory, cellular and metabolic abnormalities substantially increase mortality.

The new definitions were suggested to reflect the advances made in the pathophysiology, management and epidemiology of sepsis.

The term “severe sepsis” has been removed to highlight the fact that sepsis, by itself, is already a severe condition, making the term severe sepsis redundant.

Organ dysfunction is a key part in the definition of sepsis, and it is the main consideration that elevates uncomplicated infection to sepsis.  Suspicion of infection should prompt a search for organ dysfunction, and organ dysfunction should prompt a search for a focus of infection.

A new diagnostic tool, quickSOFA or qSOFA, was recommended, which consists of 3 simple bedside tests to identify patients at risk for sepsis.  This tool directs physicians to look for these signs: a change in mental status, decrease in SBP <100mm Hg or a respiratory rate >22/min.  Patients with 2 or more of these conditions are at higher risk of prolonged ICU stay or to die in the hospital.  For these patients, clinicians should investigate further for organ dysfunction, initiate or escalate therapy, and consider referral to critical care or increase frequency of monitoring.

The task force identified two new clinical criteria that should be used in diagnosing septic shock:  persistent hypotension requiring vasopressors to maintain MAP>/=65mmHg and blood lactate >2mmol/L despite adequate volume resuscitation.

The report has been designated as “Sepsis-3” (the first two were proposed in 1991 an 2001)

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