Download Sepsis - Rajat Pareek, M.D.

SEPSIS
Rajat Pareek, MD
Pediatric SIRS
Non specific inflammatory changes
occuring after trauma, infection,
burns, pancreatitis and other
diseases.
Definition of SIRS

1.
2.
Atleast 2 /4 cirteria, one of which MUST be
abnormal Temp/abnormal leucocyte count
Core temp >38.5, < 36
Tachycardia: >2SD above normal for age in
absence of external stimulus, chr drugs, painful
stimuli/ unexplained persistent elevation over a ½4hr time frame OR children <1 yr: bradycardia, ie
mean HR < 10th% for age in absence of vagal
stimulus/B-blocker drugs or CHD/unexplained
depression over a ½ hr time period
Def. contd
3. Resp rate <2 SD above normal for age or
mech ventilation in absence of underlying
neuromuscular disease/GA
4. WBC elevated or depressed for age (not due
to chemo induced leucopenia) OR >10%
immature neutrophils.
Definition of INFECTION
A suspected or proven (by Culture, Tissue
stain, PCR) infection caused by any
pathogen
OR
Clinical syndrome asso with high probablity of
infection.
Evidence of infection: PE findings, imaging,
labs ie CXR, petechial rash, Increased WBCs
in sterile body fluids, etc.

Definition of SEPSIS
SIRS + INFECTION= SEPSIS
Definition of SEVERE SEPSIS
SEPSIS
+
One of the foll:
1. CV organ dysfunction
2. ARDS
3. >=2 more other organ dysfunction
Definition of SEPTIC SHOCK
SEPSIS
+
CV ORGAN DYSFUN
=
SEPTIC SHOCK
Organ Dysfunction

CV Dysfunction:
Hypotension < 5th% for age OR SBP < 2SD below normal for
age
OR
2. Vasoactive drug to maintain BP (dopamine > 5mcg/kg/min or
dobutamine/epi/norepi at any dose)
OR
3.
2 of the foll:
Unexplained metabolic acidosis: base deficit >5
Increased art lactate >2 times upper limit of normal
Oliguria: UO < 0.5ml/kg/hr
Cap refill >5 sec
Core to peripheral temp gap > 3C
1.
Organ Dysfunction

Respiratory Dysfunction
1.
PaO2/FiO2 <300 in absence of CHD/Pre existing lung disease
1.
3.
OR
PaCO2 > 65 torr or 20 mm Hg over
baseline PaCO2
OR