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S epsis & the S ystemic Inflammatory Response Syndrome. PROF. FAISAL GHANI SIDDIQUI MBBS; FCPS; PGDiploma Biomedical ethics; MCPS-HPE PROFESSOR OF SURGERY. Learning Outcomes. Understand the current definitions of: Systemic inflammatory response syndrome Sepsis Severe sepsis
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Sepsis& the Systemic Inflammatory Response Syndrome PROF. FAISAL GHANI SIDDIQUI MBBS; FCPS; PGDiploma Biomedical ethics; MCPS-HPE PROFESSOR OF SURGERY
Learning Outcomes • Understand the current definitions of: • Systemic inflammatory response syndrome • Sepsis • Severe sepsis • Septic shock • Understand the pathophysiology of these conditions • Outline briefly the management of these conditions
Introduction • 400,000 – 500,000 patients affected annually in US/Europe • Significant consumption of intensive care resources • High mortality and morbidity despite advances • Greater understanding of pathophysiology • Development of novel and rational therapies
Systemic inflammatory response to infectious or non-infectious insults, manifested by two or more of the following clinical signs; • Temperature >38oC or <36oC • Tachycardia > 90 beats / minute • RR >20 breaths/minute or PaCO2 > 32 mm Hg • WBC >12,000/mm3 or < 4000/mm3 SIRS with suspected or proven infection Sepsis associated with signs of organ dysfunction secondary to tissue hypoperfusion Severe sepsis complicated by hypotension (systolic BB < 90 mm Hg), despite adequate fluid resuscitation
Small quantities of cytokines released in the circulation • Recruit macrophages • Well-controlled Trauma Acute Pancreatitis • If homeostasis is not restored, significant systemic reaction starts • Activation of numerous humoral cascades leading to loss of circulatory integrity Insult Infection Burns 1 Local Inflammation 2 Acute phase response 3 SIRS Recovery • Local response to insult / injury • Local cytokines; recruitment of neutrophils • Contain damage & repair tissue MODS / MSOF
Counter Inflammatory Response Syndrome (CARS) • Intensity and duration of SIRS depends on the balance between inflammatory and anti-inflammatory systems • CARS; activated by same stimuli • IL-4, 10 and 13 • Antagonistic action • Decreased production of TNFa, IL-1, 6, 8 • Production of antagonists • Overproduction of glucocorticoids
Disturbed Balance • Excessive activity of pro-inflammatory cytokines leads to SIRS with MODS and death • Excessive anti-inflammatory response leads to immunosuppression and increased mortality
Prevention and Treatment of MODS • Resuscitation • Airway • Breathing • Circulation • Operative Intervention • Early treatment • Safe surgery • Management on the ICU • Ventilatory support • Nutritional support