病理生理学和生存.ppt

Sepsis: Etiology, pathophysiology and survival
Michelle Harkins, MD
Objectives
Define the spectrum of disease from SIRS to septic shock
Review the epidemiology and factors that effect the severity of disease
Outline the pathophysiology of sepsis
Discuss treatment guidelines for therapy
Review UNM mortality data with the sepsis protocol
SIRS Definition
Widespread inflammatory response to a variety of severe clinical insults.
Clinically recognized by the presence of 2 or more of the following:
Temperature >38C or < 36C
Heart Rate >90
Respiratory Rate > 20 or PaCO2 <32
WBC > 12,000, < 4000 or > 10% immature forms
Sepsis
SIRS criteria + evidence of infection, or:
White cells in normally sterile body fluid
Perforated viscus
Radiographic evidence of pneumonia
Syndrome associated with a high risk of infection
Severe Sepsis
Sepsis criteria + evidence an dysfunction, including:
CV: Systolic BP < 90 mmHg, MAP < 70 mm Hg for at least 1 hour despite volume resuscitation, or the use of vasopressors.
Renal: Urine output < ml/kg body weight/hr for 1 hour despite volume resuscitation
Pulmonary: PaO2/FiO2 < 250 if an dysfunction present or < 200 if the lung is the only an.
Hematologic: Platelet count < 80K or decreased by 50% in 3 days
Metabolic: pH < and plasma lactate > x upper normal
Organ System Involvement
Circulation
Hypotension, increases in microvascular permeability
Lung
Pulmonary Edema, hypoxemia
GI tract
Translocation of bacteria, Liver Failure
Nervous System
Encephalopathy, Critical Illness Polyneuropathy
Hematologic
DIC, coagulopathy
Kidney
Acute Tubular Necrosis, renal failure
Sepsis Epidemiology
“Severe Sepsis” is the leading cause of death in (non coronary) ICU
Sepsis accounts for 40% ICU expenditures
Sepsis cases increasing @ % yearly (750,000)
Septic Shock is sepsis with hypotension despite fluid resuscitation with perfusion abnormalities.
Mortality
Sepsis: 30% - 50%
Septic Shock: 50% - 60%
Natural history of sepsis Prospective study