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Abstract
An American College of Chest Physicians/Society of Cri0cal Care Medicine Consensus
Conference was held in Northbrook in August 1991 with the goal of agreeing on a set of
deni0ons that could be applied to pa0ents with sepsis and its sequelae. New deni0ons were
oered for some terms, while others were discarded. Broad deni0ons of sepsis and the
systemic inammatory response syndrome were proposed, along with detailed physiologic
parameters by which a pa0ent may be categorized. Deni0ons for severe sepsis, sep0c shock,
hypotension, and mul0ple organ dysfunc0on syndrome were also oered. The use of severity
scoring methods when dealing with sep0c pa0ents was recommended as an adjunc0ve tool to
assess mortality. Appropriate methods and applica0ons for the use and tes0ng of new therapies
were recommended. The use of these terms and techniques should assist clinicians and
researchers who deal with sepsis and its sequelae.
Abstract
OBJECTIVE:
In 1991, the American College of Chest Physicians (ACCP) and the Society of Cri0cal Care
Medicine (SCCM) convened a "Consensus Conference," the goals of which were "to provide a
conceptual and a prac0cal framework to dene the systemic inammatory response to
infec0on, which is a progressive injurious process that falls under the generalized term 'sepsis'
and includes sepsis-associated organ dysfunc0on as well." The general deni0ons introduced as
a result of that conference have been widely used in prac0ce and have served as the founda0on
for inclusion criteria for numerous clinical trials of therapeu0c interven0ons. Nevertheless,
there has been an impetus from experts in the eld to modify these deni0ons to reect our
current understanding of the pathophysiology of these syndromes.
OLD
SEPSIS
NEW
SIRS
SUSPECTED/DOCUMENTED INFECTION
+
+ 2 or 3 on qSOFA (BAT)
Blood Pressure ( 100 mmHg syst) ,
Suspected infec0on
Altered Mental Status , Tachypnoea (RR
22 /min) +
Rise in SOFA Score by 2 or more
SEVERE
SEPSIS
SEPSIS +
SBP < 90 mmHg or MAP < 65 mmHg
Lactate > 2.0 mmol/L
INR >1.5 or PTT > 60 s
Bilirubin > 34 mol/L
Urine out put < 0.5 mL/kg/h for 2 hour
Crea0nine >177 mol/L
Platelets < 100 x 109/L
SpO2 < 90 % on room air
SEPTIC
SEPSIS
SHOCK +
HYPOTENSION
aver adequate uid resuscita0on
Category removed
SEPSIS +
VASOPRESSORS needed for MAP > 65
+
Lactate > 2 mmol/L
aver adequate uid resuscita0on
SOFA Score
qSOFA
PaO2 ( mmHg)
SO2 (%)
PaO2 ( mmHg)
80
44
91
62
81
45
92
65
82
46
93
69
83
47
94
73
84
49
95
79
85
50
96
86
86
52
97
96
87
53
98
112
88
55
99
145
89
57
90
60
Method
Nasal Cannulla
Nasopharyngeal Catheter
Es0ma0ng FiO2
O2 Flow (L/mnt)
Es&mated FiO2
0.24
0.28
0.32
0.36
0.4
0.4
0.5
0.6
0.4
6-7
0.5
0.6
0.6
0.7
0.8
0.9
10
0.95
quick
Sepsis-related
Organ
Failure
Assesment
H
No
qSOFA 2
Yes
Ward, ER
Sepsis s0ll
Suspected
?
Yes
No
SOFA 2
No
Yes
SEPSIS
No
SEPTIC SHOCK
Despite uid administra0on
1.Vasopressor required for
MAP 65 and
2. Lactate > 2 mmol/L
Yes
SEPSIS
SEPTIC SHOCK
DEFINITION
Sepsis is life-threatening organ
dysfunc0on due to dysregulated
host responses to infec0on
Clinical
Criteria
SUSPECTED/DOCUMENTED INFECTION
+
SEPSIS
2 or 3 on qSOFA (BAT)
+
Blood Pressure ( 100 mmHg syst) ,
VASOPRESSORS needed for MAP > 65
Altered Mental Status , Tachypnoea (RR
+
22/min)
Lactate > 2 mmol/L
+
aver adequate uid resuscita0on
Rise in SOFA Score by 2 or more
Recommended
primary ICD
Codes
ICD-9
ICD-10a
Sep&c shock is a subset of sepsis where
underlying circulatory and cellular/
metabolic abnormali0es are profound
enough to substan0ally increase
mortality
995.92
R65.20
785.52
R65.21