From the Guidelines
Systemic inflammatory response syndrome (SIRS) with hypotension is most commonly recognized as septic shock, a life-threatening condition requiring immediate intervention. According to the Surviving Sepsis Campaign guidelines 1, septic shock is defined as sepsis-induced hypotension persisting despite adequate fluid resuscitation. The guidelines recommend aggressive fluid resuscitation with crystalloids (30 mL/kg within the first 3 hours) as the initial management, followed by vasopressors if hypotension persists.
Key aspects of management include:
- Aggressive fluid resuscitation with crystalloids
- Use of vasopressors, such as norepinephrine, to maintain mean arterial pressure ≥65 mmHg
- Broad-spectrum antibiotics administered within 1 hour of recognition
- Source control measures implemented promptly if an infectious source is identified
- Continuous monitoring of vital signs, urine output, lactate levels, and organ function
The definition of sepsis-induced hypotension is a systolic blood pressure (SBP) <90 mmHg or mean arterial pressure (MAP) <70 mmHg or a SBP decrease >40 mmHg or less than two standard deviations below normal for age in the absence of other causes of hypotension, as stated in the guidelines 1. Another study 1 also emphasizes the importance of recognizing sepsis-induced tissue hypoperfusion or organ dysfunction, which can manifest as decreased capillary refill, skin mottling, peripheral cyanosis, or arterial hypotension.
In resource-limited settings, the recommendations for sepsis management 1 highlight the need for prompt recognition and treatment of sepsis, including the use of fluid resuscitation, antibiotics, and vasopressors as needed. The guidelines also emphasize the importance of monitoring patients closely for signs of tissue hypoperfusion and organ dysfunction.
Overall, the management of SIRS with hypotension, or septic shock, requires a multifaceted approach that targets the underlying pathophysiology of excessive inflammatory response and cardiovascular collapse, with the goal of reducing morbidity, mortality, and improving quality of life.
From the FDA Drug Label
Prolonged administration of any potent vasopressor may result in plasma volume depletion which should be continuously corrected by appropriate fluid and electrolyte replacement therapy If plasma volumes are not corrected, hypotension may recur when LEVOPHED is discontinued, or blood pressure may be maintained at the risk of severe peripheral and visceral vasoconstriction (e.g., decreased renal perfusion) with diminution in blood flow and tissue perfusion with subsequent tissue hypoxia and lactic acidosis and possible ischemic injury.
The systemic inflammation syndrome associated with hypotension is not directly mentioned, but septic shock can be inferred as the condition associated with hypotension, although it is not explicitly stated. However, lactic acidosis and tissue hypoxia are mentioned as possible consequences of severe peripheral and visceral vasoconstriction, which can occur in the context of septic shock. 2
From the Research
Systemic Inflammation Syndrome
The systemic inflammation syndrome associated with hypotension is known as septic shock. It is a common condition associated with high mortality rates, despite the best recommended resuscitation strategies in international guidelines 3, 4.
Definition and Diagnostic Criteria
Septic shock is defined as sepsis-induced hypotension persisting despite adequate fluid resuscitation 3. The diagnostic criteria for septic shock include a systolic blood pressure less than 90 mmHg, or a mean arterial pressure less than 65 mmHg after a crystalloid fluid challenge of 30 mL per kg body weight in a patient with severe sepsis 3.
Key Characteristics
Some key characteristics of septic shock include:
- Hypotension: a systolic blood pressure less than 90 mmHg, or a mean arterial pressure less than 65 mmHg 3, 4
- Organ dysfunction: septic shock is associated with organ dysfunction, including respiratory, cardiovascular, and renal failure 3, 4
- Systemic inflammatory response syndrome (SIRS): septic shock is characterized by a systemic inflammatory response, which can lead to tissue damage and organ dysfunction 3, 5
Treatment and Management
Treatment and management of septic shock typically involve: