Sun28November0333PM 15

Is it true or false that the following values would contribute towards a diagnosis of the systemic inflammatory response syndrome (SIRS)?

True / False

Bilateral infiltrates on the chest x ray Correct

A positive blood culture Correct

A white blood cell count of 20 ×109/L Correct

A temperature of 35°C Correct

A heart rate of 40 beats per minute Correct

Explanation

The systemic inflammatory response syndrome (SIRS) is common within critical care and has multiple aetiologies, including sepsis and pancreatitis. It is diagnosed when two or more of the following are present:

Body temperature less than 36°C or greater than 38°C

Heart rate greater than 90 beats per minute

Respiratory rate greater than 20 breaths per minute or a PaCO2 less than 4.3 kPa

White cell count of less than 4 ×109/L or greater than 12 ×109/L.

It is often forgotten that SIRS can exist with a low temperature and this often leads to delays in diagnosis and treatment.

A heart rate of 40 beats per minute is more likely to be a result of primary cardiac disease.

A positive blood culture is not in the diagnostic criteria for SIRS. It may be asymptomatic bacteraemia, or a contaminant. SIRS often exists in the absence of sepsis (for example, pancreatitis).

Bilateral infiltrates on the chest x ray are some of the diagnostic criteria for acute respiratory distress syndrome (ARDS) rather than SIRS.

Sequential (sepsis-related) Organ Failure Assessment (SOFA)

Organ dysfunction can be identified as an acute change in total SOFA score (equal or more than 2 points) consequent to the infection.

The baseline SOFA score can be assumed to be zero in patients not known to have preexisting organ dysfunction.

A SOFA score 2 reflects an overall mortality risk of approximately 10% in a general hospital population with

suspected infection. Even patients presenting with modest dysfunction can deteriorate further, emphasizing the seriousness

of this condition and the need for prompt and appropriate intervention, if not already being instituted.

Parameters used for a SOFA score include:

Respiratory system (PaO2/FiO2 ratio)

Nervous system (GCS)

Cardiovascular system (Mean arterial pressure or administration of inotropes)

Liver (Bilirubin)

Coagulation (Platelet count)

Renal system (Creatinine or urine output)

The Quick SOFA Score (qSOFA) was introduced by the Sepsis-3 group in February 2016 as a simplified version of the SOFA Score as an initial way to identify patients at high risk for poor outcome with an infection.

Low blood pressure (systolic equal or less than 100mmHg): 1 point

High respiratory rate (greater or equal to 22 breaths per minute): 1 point

Altered mentation (GCS<15): 1 point

The score ranges from 0 to 3 points. The presence of 2 or more qSOFA points near the onset of infection was associated with a greater risk of death or prolonged intensive care unit stay.

Reference:

Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med. 2003;29:530-8.

Society of Critical Care Medicine. Surviving Sepsis Campaign.

Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580-637.

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Mervyn Singer, MD et al. JAMA February 23, 2016 Volume 315, Number 8.

Answer Statistics

Not enough data to display the statistics

Average score: 82.44%

Times answered: 279