SIRS, Sepsis, Severe Sepsis, and Septic Shock

Septic Shock
Severe Sepsis
Sepsis Sepsis
SIRS

SIRS
2 or more of the +
Confirmed or
following:
suspected
Temp >38C or
infection
<36C
HR >90
RR >20 or
PaCO2 <32
mmHg
WBC >12k, <4k,
or >10% bands

+
Signs of End
Organ Damage*
Hypotension
(SBP <90)
Hypoperfusion
(lactic acidosis**,
oliguria, AMS)

Severe Sepsis
+
Persistent
hypotension,
despite fluid
resuscitation

SIRS = Systemic Inflammatory Response System

*Other organ dysfunction variables: arterial hypoxemia, elevated creatinine, coagulation abnormalities
(INR >1.5), thrombocytopenia (platelet count < 100,000), hyperbilirubinemia, ileus, acute lung injury.
**Currently many institutions encourage or even mandate obtaining a lactic acid level on these
patients. A lactate 4 mmol/L is considered the cutoff value for the diagnosis of severe sepsis and the
initiation of Early Goal Directed Therapy (EGDT).

Surviving Sepsis Campaign Bundles (www.survivingsepsis.org)

TO BE COMPLETED WITHIN 3 HOURS OF TIME OF PRESENTATION:
1. Measure lactate level
2. Obtain blood cultures prior to administration of antibiotics
3. Administer IV broad spectrum antibiotics
4. Administer 30ml/kg crystalloids (fluid of choice) for hypotension or lactate
4mmol/L
TO BE COMPLETED WITHIN 6 HOURS OF TIME OF PRESENTATION:
5. Apply vasopressors (for hypotension that does not respond to initial fluid
resuscitation) to maintain a mean arterial pressure (MAP) 65mmHg
a. Norepinephrine is first choice vasopressor (grade 1B)
b. Epinephrine can be added when another agent needed to maintain adequate
BP (grade 2B)
c. Low dose dopamine should not be used for renal protection (grade 1A)
6. In the event of persistent hypotension after initial fluid administration (MAP < 65 mm
Hg) or if initial lactate was 4 mmol/L, reassess volume status and tissue perfusion:
a. Measure central venous pressure (CVP) goal 8-12 mmHg
b. Measure central venous oxygen saturation (ScvO2) goal 70%+

7. Re-measure lactate if initial lactate elevated.