Key concepts

0 Sepsis is a continuum of physiologic stages defined by physiologic measures and signs and symptoms of sepsis process.

01 Gram-positive and gram-negative bacteria, fungal species, and viruses may cause sepsis.

Inflammation is the key factor in the development of sepsis. Patients with severe infections, trauma, debilitating conditions, or an immunocompromised status may experience an imbalance between inflammatory mediators that progresses to sepsis.

Û1 The cumulative burden of sepsis complications is the leading factor of mortality. The risk of death increases 20% with failure of each additional organ. Severe sepsis averages two failed organs, with a mortality rate of 40%.

Treatment is aimed at early goal-directed resuscitation; reducing or eliminating organ failures; treating and eliminating the source of infection; avoiding adverse reactions of treatment; and providing cost-effective therapy.

Appropriate empiric anti-infective therapy administered within 1 hour of the recognition of sepsis decreases complications and 28-day mortality.

Drotrecogin alfa may be utilized for patients at a high risk of mortality (as defined by Acute Physiology, Age, and Chronic Health Evaluation II [APACHE II] scores).

Sepsis is a continuum of physiologic stages characterized by infection, systemic inflammation, and hypoper-fusion with widespread tissue injury.1 The American College of Chest Physicians and the Society of Critical Care Medicine developed definitions to utilize for sepsis (Table 82—1) 2 Physiologic parameters categorize patients as having: bacteremia, infection, systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, or multiple-organ dysfunction syndrome (MODS). Standardized definitions have been developed for infections in critically ill

patients.

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