SIRS, Sepsis, Severe Sepsis,
Septic Shock, and MOF
Bryan Imayanagita
Trauma Research Associates Program
6/1/12
Systemic Inflammatory Response
Syndrome (SIRS)
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Criteria established in 1992
Related to systemic inflammation, organ
dysfunction/failure
Classified as infectious and non infectious
Non infectious causes: trauma, burn,
pancreatitis, ischemia, hemorrhage, etc
SIRS Criteria
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Temp: <36 °C (96.8 °F) or >38 °C (100.4 °F)
HR: >90/min
RR: >20/min or PaCO2<32 mmHg (4.3 kPa)
WBC: <4x109/L (<4000/mm³), >12x109/L
(>12,000/mm³)
Sepsis
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SIRS + documented infection
Evidence:
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WBC in sterile fluid (urine, CSF)
Perforated viscus
Abnormal CXR (pneumonia)
Severe Sepsis
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Sepsis associated with organ dysfunction,
hypotension, or hypoperfusion abnormalities
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lactic acidosis
Oliguria
acute alteration in mental status
Can be maintained by IVF
Septic Shock
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Refractory hypotension
Significantly decreased tissue profusion
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Organ failure
Ischemia
Cannot be maintained by IVF
25-50% mortality
Multi Organ Failure
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Homeostasis cant be maintained without intervention
2 or more organ systems
Stage 1 the patient has increased volume requirements and mild
respiratory alkalosis which is accompanied
by oliguria, hyperglycemia and increased insulin requirements.
Stage 2 the patient is tachypneic, hypocapnic and hypoxemic.
Moderate liver dysfunction and possible hematologic
abnormalities.
Stage 3 the patient develops shock with azotemia and acidbase disturbances. Significant coagulation abnormalities.
Stage 4 the patient is vasopressor dependent and oliguric or
anuric. Ischemic colitis and lactic acidosis follow.
Treatment
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Antibiotics
Early Goal Directed Therapy (EGDT)
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CVP at 10-12 cm (usually isotonic crystalloid)
If MAP <65mm Hg or BP<90 
vasopressors/dialators
SVO2 optimization by transfusion
Monitor urine output
Reduced mortality by 16%
Treatment (Cont.)
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Vasopressors: norepinephrine, dopamine
Corticosteroids
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Most beneficial in septic shock phase or ARDS
Prognosis
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25-35% severe sepsis and 40-60% of septic
shock patients die within 30 days
Severity of underlying disease most strongly
influences risk of death