Cardiovascular. Myocardial depression, which is characterized by hypotension or shock, is a hallmark of severe sepsis87. Several cytokines have direct cardiomyocyte toxic effects. Mild increases in circulating cardiac troponins are frequently present in sepsis and are indicative of sepsis severity.
The hallmarks of sepsis and septic shock are changes that occur at the microvascular and cellular level with diffuse activation of inflammatory and coagulation cascades, vasodilation and vascular maldistribution, capillary endothelial leakage, and dysfunctional utilization of oxygen and nutrients at the cellular level.
Ideally, these clinical criteria should identify all the elements of sepsis (infection, host response, and organ dysfunction), be simple to obtain, and be available promptly and at a reasonable cost or burden.
Sepsis occurs when a bacterial, viral, or fungal infection causes a significant response from the body's immune system, causing a high heart rate, fever, or fast breathing. Severe sepsis develops when the infection causes organ damage.
Serum lactate measurement may help to determine the severity of sepsis and is used to monitor therapeutic response. Peripheral blood cultures are useful for investigating the infectious etiology of sepsis and for managing appropriate antimicrobial treatment.
Blood tests
Blood samples are used to test for: Evidence of infection. Blood-clotting problems. Abnormal liver or kidney function.
NICE - the National Institute for Health and Care Excellence - urges hospital staff to treat people with life-threatening sepsis within one hour, in its quality standard. In clinical practice, this is often referred to as the 'golden hour' after diagnosis.
Taking into account the current international and local guidelines on sepsis, the four major pillars of sepsis are blood culture, antibiotics, arterial blood gas (ABG), and fluid therapy[6].
(1) Severe sepsis is sepsis with organic dysfunction, hypoperfusion or hypotension. Septic shock is sepsis-induced hypotension despite adequate fluid resuscitation in the presence of perfusion abnormalities.
a high temperature (fever) or low body temperature. a change in mental state – like confusion or disorientation. slurred speech. cold, clammy and pale or mottled skin.
PCT and CRP are both proteins produced in response to infection and/or inflammation. They are probably the two most widely used clinical tests to diagnose and manage patients with sepsis, with the exception of lactate.
Normal serum values are below 0.05 ng/mL, and a value of 2.0 ng/mL suggests a significantly increased risk of sepsis and/or septic shock. Values <0.5 ng/mL represent a low risk while values of 0.5 - 2.0 ng/mL suggest an intermediate likelihood of sepsis and/or septic shock.
The Sepsis-3 definitions suggest that patients with at least two of these three clinical variables may be prone for the poor outcome typical of sepsis: (1) low blood pressure (SBP ≤ 100 mmHg), (2) high respiratory rate (≥ 22 breaths per min), or (3) altered mentation (Glasgow coma scale < 15) (quick SOFA).
Stage two: severe sepsis
Organ dysfunction is characterized by symptoms such as decreased urine output, sudden changes in mental state, decreased blood platelet count, difficulty breathing, abnormal heart pumping function and abdominal pain.
Q7. What is the Sepsis Six Care bundle? The UK Sepsis Trust developed the 'Sepsis Six' – a set of six tasks including oxygen, cultures, antibiotics, fluids, lactate measurement and urine output monitoring- to be instituted within one hour by non-specialist practitioners at the frontline.
The sepsis triad is systemic inflammation, coagulation, and disordered fibrinolysis. There are microbial pathogens and inflammatory responses involved in the sepsis physiopathology.
Despite advances in molecular diagnostic techniques, blood culture analysis remains the gold standard for diagnosing sepsis.
IMMEDIATE EVALUATION AND MANAGEMENT — Securing the airway (if indicated) and correcting hypoxemia, and establishing venous access for the early administration of fluids and antibiotics are priorities in the management of patients with sepsis and septic shock [3,4].
Called the quick SOFA (qSOFA) score, it includes 1 point for each of 3 criteria: (1) respiratory rate ≥ 22 breaths/min, (2) altered mental status, or (3) systolic blood pressure (SBP) ≤ 100 mm Hg.
The organs more frequently affected are kidneys, liver, lungs, heart, central nervous system, and hematologic system. This multiple organ failure is the hallmark of sepsis and determines patients' course from infection to recovery or death.
Blood tests
Complete blood count (CBC): One of the key takeaways of a CBC test in the context of a sepsis diagnosis is obtaining the white blood cell (WBC) count, as these cells help fight microbes in the blood.
A single diagnostic test for sepsis does not yet exist, and so doctors and healthcare professionals use a combination of tests and immediate and worrisome clinical signs, which include the following: The presence of an infection. Very low blood pressure and high heart rate. Increased breathing rate.