From the Guidelines
Sepsis is a life-threatening condition that requires prompt recognition and treatment, characterized by organ dysfunction attributed to an infection and a dysregulated host response 1.
Key Characteristics of Sepsis
- Organ dysfunction: can be represented by an increase in the SOFA score of 2 points or more 1
- Dysregulated host response: can lead to tissue hypoxia, direct tissue damage, and ultimately, organ failure 1
- Infection: can be caused by various pathogens, and the host response depends on the causative pathogen and the host's genetic characteristics and co-existing illnesses 1
Diagnosis and Treatment
- Early recognition: is crucial for effective treatment, and prompt administration of intravenous fluids and vasopressors are mandatory 1
- Fluid resuscitation: should be guided by clinical endpoints, such as mean arterial pressure, skin color, and capillary refill 1
- Vasopressors: such as norepinephrine or epinephrine, may be necessary to maintain adequate blood pressure and perfusion of vital organs 1
- Broad-spectrum antibiotics: such as ceftriaxone or meropenem, should be administered promptly to treat the underlying infection 1
Important Considerations
- Septic shock: is a subset of sepsis, characterized by profound circulatory, cellular, and metabolic abnormalities and a higher risk of mortality 1
- Organ dysfunction: can be reversible if treated promptly and effectively, but delayed diagnosis and treatment can lead to poor outcomes 1
From the Research
Definition of Sepsis
- Sepsis is a life-threatening condition that occurs when the body's response to an infection becomes unregulated, leading to organ dysfunction 2, 3, 4, 5, 6.
- It is a major contributor to morbidity and mortality worldwide, with a high incidence in the pediatric population 2.
- The definition of sepsis has been updated to focus on the dysregulation of the host response to infection, leading to life-threatening organ dysfunction 2, 5, 6.
Clinical Manifestations
- Sepsis can manifest subtly, particularly in older patients and those who are immunocompromised 6.
- Common sources of sepsis include respiratory, gastrointestinal, genitourinary, and skin and soft tissue infections, with pneumonia being the most common cause 6.
- Septic shock is the most severe form of sepsis, characterized by a drop in blood pressure, decreased tissue perfusion, and hypoxia 5.
Diagnosis and Management
- Timely diagnosis is crucial for patient outcomes, and emergency physicians play a critical role in recognizing and treating septic patients 5.
- The Sequential Organ Failure Assessment (SOFA) score is a useful tool for early diagnosis 6.
- Initial management includes fluid resuscitation, antimicrobial therapy, and vasopressor therapy as needed 2, 4, 6.
- Guidelines recommend administering intravenous crystalloids and starting antimicrobials within the first hour of diagnosis 2, 4, 6.