Immediate Treatment of Systemic Inflammatory Response Syndrome (SIRS)
The immediate treatment of SIRS requires aggressive fluid resuscitation, early source control when infection is suspected, and prompt empiric broad-spectrum antibiotics if sepsis is likely, with vasopressors added for hemodynamic instability. 1
Initial Resuscitation and Hemodynamic Support
Begin judicious intravenous fluid resuscitation immediately and titrate based on clinical response rather than following rigid predetermined protocols. 1
Add vasopressor agents if the patient remains hemodynamically unstable despite adequate fluid resuscitation. 1
The goal is to achieve supranormal resuscitation levels with aggressive monitoring and support of target organs, as anticipation rather than reaction is key to successful SIRS management. 2
Source Control
Identify and control the source of SIRS immediately, particularly when caused by intra-abdominal infections or other identifiable sources. 1
Do not delay source control measures while waiting for patient stabilization, as this significantly worsens outcomes and increases mortality risk. 1
In patients with septic shock, invasive source control may need to proceed even during ongoing resuscitation if the patient is at risk of death. 1
Antibiotic Therapy
Initiate empiric broad-spectrum antibiotics promptly when infection is suspected or confirmed, particularly in patients with signs of organ failure such as hypotension, oliguria, or decreased mental alertness. 1
Start antibiotics while awaiting culture results rather than delaying for microbiological confirmation. 1
For SIRS associated with skin and soft tissue infections, select antibiotics based on likely pathogens and local resistance patterns. 1
Avoid reflexive antibiotic prescription for SIRS criteria alone without evidence of actual infection, as this contributes to antimicrobial resistance. 3
Monitoring and Surveillance
Perform serial laboratory testing to assess response to therapy and guide ongoing management. 1
Conduct periodic cultures of sputum, urine, and blood for fungal and bacterial organisms in high-risk patients. 1
Monitor for development of multiple organ dysfunction syndrome (MODS), as SIRS can progress to compromise various organ systems. 4
Common Pitfalls to Avoid
Never delay source control while attempting to fully stabilize the patient first—this is associated with adverse outcomes including death. 1
Do not withhold antibiotics in patients with SIRS plus organ dysfunction while waiting for definitive microbiological diagnosis. 1
Recognize that SIRS criteria (≥2 of: temperature >38°C or <36°C, heart rate >90 bpm, respiratory rate >20 breaths/min, white blood cell count >12,000 or <4,000 cells/μL) can occur from non-infectious causes including trauma, pancreatitis, and surgery. 3, 4
In post-operative patients within 48 hours, SIRS is often due to the normal inflammatory response to surgical trauma rather than infection—do not automatically prescribe antibiotics without evidence of actual infection. 3