SIRS, sepsis, MODS

what is the definition of SIRS?

systemic inflammatory response syndrome

what is the definition of sepsis?

SIRS + infection

what is the definition of severe sepsis?

sepsis + organ failure

what is the definition of septic shock?

sepsis + hemodynamic instability (form of distributive shock)

what is the definition of MODS?

multi-organ dysfunction syndrome

what is the progression of least to worst regarding sepsis stuff?

SIRS, sepsis, severe sepsis, septic shock

what is the ultimate goal regarding SIRS?

recognizing it and preventing severe sepsis, septic shock, and/or MODS

how to dx someone with SIRS?

meeting 2 or more of the 4 criteria

what are the criteria to meet SIRS?

temp greater than 38C or less than 36C, HR greater than 90, RR greater than 20 or PaCO2 less than 32, WBC greater than 12 or less than 4 (also don’t want bands greater than 10%)

why is having elevated bands bad?

sending out babies to fight a battle bc all the adults have died

what is an analogy to use for SIRS?

traffic and the ambulance can’t get through → too many inflammatory mediators and other infection-fighting cells clogging the veins and preventing oxygen and other important things to get to tissues

what are some risk factors for SIRS?

age (too young/too old), immunosuppression, baseline organ dysfunction, compromised gut, malnutrition, obesity

what are some treatment priorities for SIRS?

find and tx the cause/infection and prevention of progression

what is the relation between SIRS and septic patients?

almost all septic patients have SIRS but not every SIRS patient is septic → true incidence of SIRS is unknown

what happens to the veins in septic patients?

increased permeability (causing edema) → “exits” in traffic jam analogy; also hypercoaguability → traffic jam blocking everything and causing things to go out of “exits”

what are some labs we do NOT use for SIRS?

• CRP (c-reactive protein) → indicates non-specific inflammation

• lactate → too late if it’s sepsis and doesn’t always mean sepsis (can indicate poor tissue perfusion)

• serum leptin → could be dysfunctional in much of the population

• IL-6 → high levels correlate to incidence of MODS and death

what is the best lab used to predict SIRS?

procalcitonin → consistently correlates with infection and predicts sepsis

what are the crucial actions to be done within an hour for a patient with a source of infection and SIRS?

draw lactate, draw blood cultures, give broad spectrum abx, rapid admin of 30 mL/kg crystalloids (if hypotensive or lactate > 4), give vasopressors after fluids if MAP remains < 65

what organ are the first to fail?

lungs → usually d/t metabolic acidosis or increased permeability leading to fluid-filled alveoli; support w non-invasive ventilation or mechanical ventilation

how to support kidneys in MODS?

fail fairly quickly d/t hypotension → need to support w adequate fluid, monitor urine output and electrolyte balance, maintain MAP > 65, CRRT may be necessary

what is our priority when it comes to the endocrine system relating to SIRS?

maintain tight glucose control, will usually have the pt on an insulin drip

how to support the cardiovasc system in MODS?

choose vasopressors that don’t incr myocardial oxygen demand, keep MAP > 65 and paO2 > 80, support w inotropes

what is the last system that we really worry about in MODS and how do we support it?

GI → poor perfusion; give pepcid and protonix to reduce stress ulcers and absorption of nutrients, give trickle feeds

what is the minimal pH needed to support brain function?

7.2 → dysfunctions at 7.1 or lower

how to support the hematological system in MODS?

place SCDs, give heparin SUBQ, advocate for colloids or blood as needed → watch for hypercoagulation on labs or s/s