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Author: Dr Graham Grove, 2016

Sepsis describes the systemic condition that is associated with infection (presumed or identified). It is a life-threatening acute illness that occurs relatively frequently in patients with palliative illnesses and at times it can be difficult to know if a patient's deterioration is due to sepsis or due to progression of their underlying illness. Sometimes this distinction is unimportant as it is clear that the person is in the last few days or weeks of life from their palliative illness, however at other times, this distinction is important because active treatment of sepsis can be very effective. Although many patients can be cured from their acute infection, some never recover to their pre-infection function, for example, sometimes some mobility or cognitive impairment remains post-treatment.

In addition to patients with palliative illnesses such as advanced cancer who develop sepsis, palliative care teams may be asked to be involved in symptom relief and psychological support for previously non-palliative patients in intensive care and critical care units who have developed multiple organ failure with little chance of recovery in the context of sepsis and where treatment is being withdrawn.

Sepsis refers to the systemic condition that ocurs in associated with severe infections. Some of the following features will be noted:

Signs may include
Raised temperature (e.g. temp > 38.3) or a low temperature (e.g. temp < 36.0)
Tachycardia (e.g. heart rate > 90)
Tachypnoea (e.g. RR > 20)
New confusion or drowsiness
Signs of a positive fluid balance or oedema
Raised blood sugar (> 7.7) in a non-diabetic person
Evidence of reduced tissue perfusion (e.g. decrfeased capillary refill)
Hypotension (systolic BP < 90 or MAP < 70 or systolic BP decrease > 40)
Blood tests of inflammation
Rasied white cell count (> 12) or reduced white cell count (< 4) or > 10% precursor white cells circulating (e.g. myelocytes and metamyelocytes)
Raised CRP
Others: raised procalcitonin, raised lactate (> 1)
Features of organ failure
Hypoxaemia (low PaO2)
Oliguria (urine output < 0.5 ml/kg/hour despite adequate fluid resuscitation)
Creatinine increase of > 44)
Deranged coagulation with INR > 1.5 or APTT > 60)
Thrombocytopaenia (platelets < 100)
Absent bowel sounds consistent with an ileus
Raised bilirubin > 70

Severe sepsis is defined as sepsis with any of the following:

  • Hypotension
  • Raised lactate
  • Acute lung injury in the absence of pneumonia
  • Renal failure with either
    • Urine output down as per the table above despite fluid resuscitation
    • Creatinine > 176
  • Bilirubin > 70
  • Platelets < 100
  • INR > 1.5

Septic shock is defined as sepsis with hypotension despite adequate fluid resucitation (defined as 30 ml/kg - in a 70kg man this would be 2.1 litres).

SIRS, or systemic inflammatory response syndrome, is a term used to describe the systemic inflammatory effects of any severe non-infective insult, although, because in practice, sepsis and SIRS look the same clinically, this distinction is often ignored and the terms are almost used interchangeably.

When taking a history and examining a patient with sepsis, it is very important to look for symptoms and signs that might help determine the source of infection, e.g.

  • Acute red painful rash on the legs –> suggests cellulitis
  • Cough productive of sputum and dyspnoea –> suggests a lower respiratory tract infection
  • Suprapubic tenderness and dysuria –> suggests a UTI
  • Right upper quadrant pain and fever –> suggests cholecystitis or a biliary tract infection
  • Headache and vomiting –> might suggest meningitis
  • Tenderness and eryhthema around a centra or PICC line –> might suggest a line infection
  • sepsis.1564982251.txt.gz
  • Last modified: 2019/08/05 15:17
  • by Graham Grove