What is the treatment for Systemic Inflammatory Response Syndrome (SIRS)?

Treatment of Systemic Inflammatory Response Syndrome (SIRS)

The treatment of Systemic Inflammatory Response Syndrome (SIRS) requires a stepwise approach focusing on source control, supportive care, and targeted immunomodulatory therapy based on the underlying cause and severity of presentation.

Source Control and Initial Management

• Source control is essential in managing SIRS, particularly when caused by intra-abdominal infections or other identifiable sources 1
• Early recognition of SIRS is crucial for effective treatment, with prompt administration of empiric broad-spectrum antibiotics when infection is suspected 1
• Judicious intravenous fluid resuscitation should be initiated and titrated based on clinical response rather than predetermined protocols 1
• Vasopressor agents may be necessary to augment fluid resuscitation in patients with hemodynamic instability 1
• Delay in providing adequate source control has been associated with adverse outcomes including death in SIRS with intra-abdominal sepsis 1

Antibiotic Therapy

• Antibiotic therapy is recommended for patients with SIRS when infection is suspected or confirmed 1
• Antibiotics should be initiated promptly in patients with SIRS and signs of organ failure such as hypotension, oliguria, or decreased mental alertness 1
• Empiric broad-spectrum antibiotic coverage should be started while awaiting culture results 1
• For SIRS associated with skin and soft tissue infections, antibiotic selection should be guided by likely pathogens and local resistance patterns 1
• Duration of antibiotic therapy should be 7-14 days for SIRS requiring antibiotics, based on clinical response 2

Immunomodulatory Therapy

• For SIRS associated with MIS-C (Multisystem Inflammatory Syndrome in Children), a stepwise approach to immunomodulatory treatment is recommended 1
• Intravenous immunoglobulin (IVIG) and/or glucocorticoids are considered first-tier agents for SIRS related to MIS-C 1
• IVIG at a dose of 2 gm/kg based on ideal body weight is recommended for MIS-C patients requiring hospitalization 1
• Low-to-moderate dose glucocorticoids (1-2 mg/kg/day) should be used as adjunctive therapy with IVIG in patients with shock and/or organ-threatening disease 1
• Corticosteroids should NOT be used to control elevated intracranial pressure in patients with acute liver failure and associated SIRS 1

Management of Specific Complications

• For SIRS with coagulopathy, vitamin K (5-10 mg subcutaneously) should be administered, but correction with fresh frozen plasma is only indicated for invasive procedures or profound coagulopathy 1
• Surveillance for infection is necessary in SIRS patients, with periodic cultures of sputum, urine, and blood for fungal and bacterial organisms 1
• Prophylactic antibiotics and anti-fungals may be considered in high-risk SIRS patients but have not been definitively shown to improve overall outcomes 1
• For SIRS with gastrointestinal bleeding risk, histamine-2 receptor blocking agents such as ranitidine can be used for prophylaxis 1

Monitoring and Follow-up

• Serial laboratory testing and cardiac assessment should guide the immunomodulatory treatment response and tapering in SIRS associated with MIS-C 1
• Patients with SIRS may require a 2-3 week taper of immunomodulatory medications 1
• For SIRS with cardiac involvement, electrical conduction abnormalities should be monitored with EKGs at minimum every 48 hours in hospitalized patients 1
• Sequential monitoring of inflammation markers is recommended to assess response to therapy 1

Special Considerations

• In patients with SIRS and septic shock, invasive source control may need to proceed even during ongoing resuscitation if the patient is at risk of death 1
• SIRS following cardiovascular interventions may require non-steroidal anti-inflammatory drugs or corticosteroids, with diagnosis supported by lack of response to antibiotics and negative cultures 3
• For recurrent SIRS episodes, search for local causes and early drainage of any recurrent abscesses 2
• Probiotics have been studied in critically ill patients with SIRS but evidence for their routine use remains limited 1

Common Pitfalls to Avoid

• Delaying source control measures while waiting for patient stabilization can worsen outcomes in severe SIRS 1
• Overuse of antibiotics in SIRS without confirmed infection can contribute to antimicrobial resistance 1
• Failing to consider MRSA coverage in areas with high MRSA prevalence when treating SIRS associated with skin infections 2
• Overlooking the need for source control (drainage) when using antibiotics for SIRS associated with abscesses or other collections 2