Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ INTRODUCTION ++ Sepsis is a life-threatening condition that is characterized by an inflammatory response caused by an infection. Identifying and treating sepsis early is key to saving lives. Following are the sepsis definitions and treatment guidelines to help frame your approach to critically ill patients who have a suspected or confirmed diagnosis of sepsis. +++ DEFINITION ++ An international pediatric sepsis consensus conference published a definition for pediatric systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock and organ dysfunction in 2005.1 Definitions in Table 29-1.1 Examples of organ dysfunction1: Cardiovascular: Despite 40 cc/kg intravenous fluid given over 1 hour, patient has either hypotension, need for vasoactive infusion to maintain blood pressure, or evidence of decreased perfusion (ex: capillary refill >5 seconds, arterial lactate greater than two times normal) Respiratory: Need for invasive or noninvasive positive pressure support, PaO2:FiO2 <300, requirement of >50% FiO2 to maintain saturations ≥92%, or PaCO2 >65 torr Renal: Serum creatinine more than two times upper limit of normal for age or twofold increase in baseline creatinine Hepatic: Total bilirubin ≥4 mg/dL (except newborns), ALT two times upper limit of normal Neurologic: Glasgow Coma Score ≤11 or acute change in mental status Hematologic: Platelet count <80,000/mm3 or 50% drop in platelet count from highest value in previous 3 days (for chronic hematology/oncology patients) or INR >2 ++ ++Table Graphic Jump LocationTABLE 29-1Definition of Sepsis View Table||Download (.pdf) TABLE 29-1 Definition of Sepsis Systemic Inflammatory Response Syndrome (SIRS) Presence of two out of four: Core temperature >38.5°C or <36°C HR >2 SD above normal for age (in absence of external stimulus such as pain) OR HR (if < 1 year of age) <10th percentile for age in absence of vagal stimulus Mean RR >2 SD above normal for age OR mechanical ventilation for acute process (not due to neuromuscular disease or anesthesia) Leukocyte count elevated or depressed for age OR >10% immature neutrophils Infection Suspected or proven (as with positive culture, PCR test) OR high probability of infection (such as presence of white blood cells in a usually sterile site) Sepsis SIRS in the presence of or as a result of infection Severe Sepsis Sepsis plus either cardiovascular organ dysfunction, acute respiratory distress syndrome, OR two or more organ dysfunctions Septic Shock Sepsis plus cardiovascular organ dysfunction +++ PATHOPHYSIOLOGY OF SEPSIS – THE BASICS ++ The host response to infection triggers both an inflammatory and compensatory anti-inflammatory response (CARS) mediated by the immune system. The balance between these two determines the extent of organ injury and patient recovery. The innate immune response is nonspecific and triggered by the body's recognition of antigen resulting in an effector response. Components of the innate immune system include physical barriers like skin ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.