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