Sepsis and SIRS

 Severe sepsis affects 500,000 annually in the United States

 Despite improvements in critical care mortality of 20-50% remains
unchanged

Definitions

Condition Definition
Bacteraemia The presence of viable bacteria in the bloodstream

SIRS The systemic inflammatory response to a variety of

clinical insults manifest by two or more of the following:

 Temperature >38C or <36

 Heart Rate > 90 bpm
 Respiratory Rate > 20 breaths per minute or
PaCO2 > 4.3 kPa White Cell Count > 12,000 or
<4,000 per mm3

Sepsis SIRS with documented infection

Severe SIRS with documented infection and hypoperfusion,
SIRS hypotension and organ dysfunction
Septic Sepsis with hypotension despite adequate fluid
Shock resuscitation

Clinical features of sepsis and SIRS

 Cardiorespiratory effects
o Increased cardiac output
o Decreased vascular resistance
o Increased oxygen consumption
o Fever or hypothermia
o Tachycardia
o Tachypnoea
 Metabolic or haematological effects
o Respiratory alkalosis
o Deranged liver function
o Deranged renal function
o Altered whit cell count and platelets
o Disseminated intravascular coagulation

Aetiology of SIRS

SIRS can arise from a number of aetiological triggers

 Infection – bacterial, viral, fungal

 Hypovolaemic shock
 Trauma
 Burns
 Tissue ischaemia
  Pancreatitis

Bacterial Infection is commonest cause

 50% due to gram-negative organisms

 40% due to gram-positive organisms

Mechanisms in the pathology of SIRS

 Over-production of inflammatory mediators
 Under-production of anti-inflammatory mediators
 Receptor abnormalities
 Decreased destruction of inflammatory mediators
 Abnormal leukocytes

Major inflammatory mediators involved in SIRS

 Platelet activating factor
 Tumour necrosis factor -alpha
 Interleukin-1
 Interleukin-6
 Interleukin-8
 Interleukin-10

Bibliography

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dysregulation of immune function and therapeutic implications. Surg J R Coll
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Cohen J. The immunopathogenesis of sepsis. Nature 2002; 420: 885-891.

Parker S J, Watkins P E. Immunomodulatory therapies of sepsis and SIRS.

In: Johnson C D, Taylor I eds. Recent advances in surgery 23. Edinburgh,
Churchill Livingston 2000: 55-68.

Paterson R L, Webster N R. Sepsis and the systemic inflammatory response

syndrome. J R Coll Surg Ed 2000; 45: 178-182.

Vincent J L, de Carvalho F B, de Backer D. Management of septic shock. Ann

Med 2002; 34: 606-613.

Wheeler A P, Bernard G R. Treating patients with severe sepsis. N Eng J Med

1999; 340: 207-214.