Sepsis

SIRS

= two or more of:

  • Temperature >38°C or <36°C

  • Heart rate >90/min

  • Respiratory rate >20/min or PaCO2 <32mmHg (4.3 kPa)

  • White blood cell count >12 000/mm3 or <4000/mm3 or >10% immature bands

Sepsis

Definitieu: Life-threatening organ dysfunction caused by a dysregulated host response to infection.

Organ dysfunction: acute change in SOFA score ≥2 points consequent to the infection, reflecting an overall mortality risk of 10%.

Quick SOFA: qSOFA describes alteration in mental status, systolic blood pressure ≤100mmHg, or respiratory rate ≥22/min.

Septische shock

Definitie: subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality. Can be identified with a clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP ≥65mmHg and having a serum lactate level >2 mmol/L despite adequate volume resuscitation. With these criteria, hospital mortality is >40%.

Refractaire shock = septische shock >1hr, niet reagerend op vulling/inotropie

Steroiden in shock:

  • CORTICUS trial: geen survival benefit, wel sneller hemodynamisch herstel

  • APROCCHSS trial NEJM 2018: survival benefit van 7dg LD steroïden, zieke patienten groep

  • ADRENAL trial NEJM 2018: geen benefit van steroïden