Sepsis 3 – the Death of SIRS?

The European Society of Intensive Care Medicine and The Society of Critical Care Medicine have redefined sepsis with their “Sepsis Rededinitions Task Force”.  This has been published in the most recent edition of JAMA.

There are still issues with the new definitions – can they be applied to all patients, do they apply to patient from low income areas, are the scoring tools relevant to Australian practice?  Regardless of this, it is a hot topic in critical care medicine and you need to be familiar with the new terms that you will soon hear being bandied about.

In summary:
1.  SIRS criteria are out the door
2.  Sepsis is now the presence of life-threatening organ dysfunction due to a dysregulated host response to infection
3.  Organ dysfunction is defined by a 2-point increase in the SOFA score (this is an ICU scoring system not commonly used in Australia)
4.  A modified version of this score (qSOFA) can be used at the bedside to identify those patients with a suspected infection who are at risk of a higher mortality – the score looks at conscious state, blood pressure, and resp rate
5.  Septic shock is now defined as hypotension where vasopressors are required to maintain MAP > 65mmHg AND a lactate level >2mmol/L

JAMA have kindly produced a brief explanatory video of the above info.

So, know the new terms, but don’t under-treat your next potential sepsis patient just because they don’t necessarily meet all the new criteria – clinical judgement still trumps at the moment.  Watch this space.

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