critical care medicine
Sepsis and Septic Shock
Introduction
Sepsisis a clinical syndrome of life-threatening organ dysfunction caused by a dysregulated response to infection. Inseptic shock, there is critical reduction in tissue perfusion; acute failure of multiple organs, including the lungs, kidneys, and liver, can occur. Common causes in immunocompetent patients include many different species of gram-positive and gram-negative bacteria. Immunocompromised patients may have uncommon bacterial or fungal species as a cause. Signs include fever, hypotension, oliguria, and confusion. Diagnosis is primarily clinical combined with culture results showing infection; early recognition and treatment is critical. Treatment is aggressive fluid resuscitation, antibiotics, surgical excision of infected or necrotic tissue and drainage of pus, and supportive care. (See also Shock and Sepsisrepresents a spectrum of disease with mortality risk ranging from moderate (eg, 10%) to substantial (eg,>40%) depending on various pathogen and host factors along with the timeliness of recognition and provision of appropriate treatment. 18 mg/dL [2 mmol/L] despite adequate volume resuscitation [ General reference ]). The concept of the systemic inflammatory response syndrome (SIRS), defined by certain abnormalities of vital signs and laboratory results, has long been used to identify early sepsis. However, SIRS criteria have been found to lack sensitivity and specificity for increased mortality risk, which is the main consideration for using such a conceptual model. The lack of specificity may be because the SIRS response is often adaptive rather than pathologic. 