Sepsis @ acute-illness.com

Sepsis is a massive challenge in modern medicine.  Despite significant investment in researching the condition the mortality rate, the percentage of people who die, is still shockingly high.  During this short post I’m going to try and answer the question, “What is sepsis?”

Over-reaction

The prevailing theory is that sepsis represents an uncontrolled inflammatory reaction to some insult.  Usually this insult would be an infection.  An almost identical condition, termed SIRS, systemic inflammatory response syndrome, can occur without infection and typically follows some form of trauma.

A lack of an agreed upon a definition plagued clinical trials and patient treatment until a little over a decade ago a consensus conference defined sepsis as ‘infection with evidence of systemic inflammation’.  Systemic inflammation was considered to be present if two or more of the following conditions were met

- Increased or decreased temperature
- Increased or decreased leukocyte (white blood cell) count
- Tachycardia (rapid heart beat)
- Rapid breathing

This was the first time the term SIRS was needed.  By including infection in the definition of sepsis a new term was needed for ’sepsis’ without infection and SIRS was coined.

Severe sepsis and septic shock

The term sepsis was further broken up with severe sepsis and septic shock used.  Severe sepsis is sepsis with organ dysfunction, frequently the lungs or kidneys.  The more organs that fail the higher the mortality rate.

Septic shock is severe sepsis with hypotension, low blood pressure, that persists after the administration of intravenous fluid.  The blood vessels are dilatated (widened) and the capillaries are more permeable than they should be.  This causes there to be less resistance to blood flow and the pressure drops.  The best analogy would be the garden hose.  If you pinch the end the water shoots out a good distance because it is under pressure but if you don’t pinch the end you get just a trickle.

That trickle isn’t enough to supply oxygen and nutrients to the body fast enough and you get hypoperfusion, hypoxia and organ dysfunction.

These are issues from basic sepsis onwards getting worse with severe sepsis until in septic shock the body is unresponsive to fluid administration.

In future articles I’ll discuss the symptoms of sepsis in greater detail and talk about the appropriate treatments.