SEPSIS Rajat Pareek, MD

Pediatric SIRS Non specific inflammatory changes occuring after trauma, infection, burns, pancreatitis and other diseases.

Definition of SIRS Atleast 2 /4 cirteria, one of which MUST be abnormal Temp/abnormal leucocyte count Core temp >38.5, < 36 Tachycardia: >2SD above normal for age in absence of external stimulus, chr drugs, painful stimuli/ unexplained persistent elevation over a ½-4hr time frame OR children <1 yr: bradycardia, ie mean HR < 10th% for age in absence of vagal stimulus/B-blocker drugs or CHD/unexplained depression over a ½ hr time period

Def. contd 3. Resp rate <2 SD above normal for age or mech ventilation in absence of underlying neuromuscular disease/GA 4. WBC elevated or depressed for age (not due to chemo induced leucopenia) OR >10% immature neutrophils.

Definition of INFECTION A suspected or proven (by Culture, Tissue stain, PCR) infection caused by any pathogen OR Clinical syndrome asso with high probablity of infection. Evidence of infection: PE findings, imaging, labs ie CXR, petechial rash, Increased WBCs in sterile body fluids, etc.

SIRS + INFECTION= SEPSIS Definition of SEPSIS SIRS + INFECTION= SEPSIS

Definition of SEVERE SEPSIS + One of the foll: 1. CV organ dysfunction 2. ARDS 3. >=2 more other organ dysfunction

Definition of SEPTIC SHOCK SEPSIS + CV ORGAN DYSFUN = SEPTIC SHOCK

Organ Dysfunction CV Dysfunction: Hypotension < 5th% for age OR SBP < 2SD below normal for age OR 2. Vasoactive drug to maintain BP (dopamine > 5mcg/kg/min or dobutamine/epi/norepi at any dose) 2 of the foll: Unexplained metabolic acidosis: base deficit >5 Increased art lactate >2 times upper limit of normal Oliguria: UO < 0.5ml/kg/hr Cap refill >5 sec Core to peripheral temp gap > 3C

Organ Dysfunction Respiratory Dysfunction PaO2/FiO2 <300 in absence of CHD/Pre existing lung disease OR PaCO2 > 65 torr or 20 mm Hg over baseline PaCO2 3.