SLR - October 2017 - Leslie Joseph

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

Reference:
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opai SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801–10.

Scientific Literature Review

Reviewed By: Leslie Joseph, DPM
Residency Program: SSM Health DePaul Hospital, St. Louis, MO

Podiatric Relevance: Sepsis and septic shock are serious conditions that account for increasing mortality rates among patients and is a legitimate concern for medical providers across the country. Therefore, it is important to stay current with the literature and the ever-changing advances in the field so that we can treat our patients more effectively and with better understanding of these clinical processes. The definitions of sepsis and septic shock were last revised in 2001.

Methods: A task force was created to generate innovative definitions and clinical criteria by using Delphi process, meetings, voting and research. The task force concluded that the term "severe sepsis" was redundant. They not only wanted to create a more reliable and reproducible picture of sepsis identification, but also wanted to enhance the clinical recognition of sepsis.

Results: The new definition of sepsis that was recommended was a life-threatening organ dysfunction caused by a dysregulated host response to infection. Clinically, sepsis can be defined by two points or more using the SOFA (Sequential Organ Failure Assessment) scale. Septic shock should be defined as a subset of sepsis in which profound circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. In septic shock, it is important to consider acute circulatory failure and the increase in lactate levels and hypotension. As a quick clinical reference to identify a patient with sepsis, the SOFA scale is recommended. Here, the presence of two of the following criteria is adequate to suspect sepsis: respiratory rate of 22/min or greater, altered mentation, or systolic blood pressure of 100 mm Hg or less.

Conclusion: The new sepsis and septic shock definition provides a treatment algorithm for early recognition of sepsis, leading to improved patient outcomes. Previous SIRS criteria may have been inadequate, particularly among immunocompromised patients who lack an appropriate host-immune response. The new sepsis and septic shock guidelines may prove beneficial to the podiatric surgeon in recognizing early onset sepsis, leading to improved patient care and reduction in an adverse event or patient mortality.

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