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Clinical Sepsis: Systemic Inflammatory Response Syndrome and Higher Mortality Rates

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    Sepsis is a systemic inflammatory response to infection; it is the leading cause of death in intensive care units (Shimaoka, Park, 2008). The body may develop the inflammatory response to microbes in the blood, urine, lungs, skin and other tissues. Sepsis is usually treated in the ICU with antibiotic therapy and Intravenous fluids. These patients require preventative measures for deep vein thrombosis, stress ulcer and pressure ulcers. The first 6 hours are known to be the most crucial time.

    This has been associated with higher mortality rates within the last 5 years, more than 75,000 patients die of septic shock every year in the US and is the tenth most common cause of death overall. Manifestations of the systemic inflammatory response syndrome (SIRS) include abnormalities in temperature, heart, respiratory rates and leukocyte counts. This is a form of severe sepsis that arises from a noninfectious cause. Sepsis is defined by the presence of 2 or more SIRS criteria in the setting of a documented or presumed infection (Rivers, McIntyre, Morro, Rivers, 2005).

    The condition may manifest into severe sepsis or septic shock. Severe sepsis is characterized by organ dysfunction, while septic shock results when blood pressure decreases and becomes extremely hypotensive even with the administration of fluid resuscitation. The initial presentation of severe sepsis and septic shock is usually nonspecific. Patients admitted with relatively benign infection can progress in a few hours to a more devastating form of the disease. The transition usually occurs during the first 24 hours of hospitalization.

    The reason for this is that there is a dramatic decrease in tissue oxygen delivery and causes cardiovascular insufficiency. This is the only widow of opportunity in trying to fight the disorder. The initial response the body has to the infection is known as a humoral cellular and neuroendocrine reaction. In this response, white blood cells such as neutrophils, monocytes, macrophages, basophiles, and platelets interact with endothelia cells. This interaction along with the inflammatory response causes an impairment of the microvascular flow, creating a local ischemia and hypoxia, impairing cellular respiration.

    This all leads to generalized edema in the patient. Treatment with early antimicrobial therapy has improved helped improved the morbidity and mortality rates in the ICU settings. This is seen when antibiotics are administered within 4 and 8 hours of hospitalization. Early goal-directed treatment is an approach used to significantly reduce the mortality rate of patients as well. EGDT is an algorithmic approach of hemodynamic optimization that aims to restore the balance between oxygen supply and demand in cases of severe sepsis of septic shock with the first 6 hours of care (Rivers, McIntyre, Morro, Rivers, 2005).

    This treatment focuses on adequate oxygen delivery by optimization of intravascular volume with the use of central venous pressure monitoring and blood pressure to restore the balance between systemic oxygen delivery and oxygen demand to resolve the issue of tissue hypoxia. Another intervention that is used is the administration of steroid therapy. Research trials are still being conducted under this therapy, but they have already noted a 10% reduction in the mortality rate.

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    Clinical Sepsis: Systemic Inflammatory Response Syndrome and Higher Mortality Rates. (2018, May 17). Retrieved from

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