SEPSIS-3: UPDATED MAIN DEFINITIONS, POTENTIAL PROBLEMS AND NEXT PRACTICAL STEPS
https://doi.org/10.21292/2078-5658-2016-13-4-4-11
Abstract
Goal: to review new definitions and criteria of sepsis and septic shock by Society Critical Care Medicine (SCCM) and European Society Intensive Care Medicine (ESICM) in the light of evolving understanding of interaction between the contagium and the host, appearance of potential problems and possible clinical benefits for the practice. Results. Upon results of the review the conclusion has been made that the sepsis is to be considered not only as progressing system inflammation but given the diversity of the response – as life threatening regulation disorder of the host reaction (disregulation) to the infection with acute multi-organ dysfunction reflecting the tissue damage of the host. SOFA score is to be used as a diagnostic tool. The introduction of the new concept into routine practice is limited since it can be difficult to define the contribution of the infection into already existing dysfunction due to the presence of some chronic disorder, since doctors do not adhere to using scales of multi-organic failure severity and it is impossible to test blood lactate in numerous medical units. Introduction of new criteria into practice can be beneficial for the justification of the care provision in hospital due to the risk of the unfavorable outcome and with the purpose of targeted monitoring. Quick SOFA is to be used to detect patients with the suspicion of sepsis and developing life threatening conditions beyond premises the intensive care departments.
About the Authors
V. A. Rudnov
Ural State Medical University, Yekaterinburg;
Municipal Clinical Hospital no. 40, Yekaterinburg
Russian Federation
Doctor of Medical Sciences, Professor, Head of Anesthesiology, Intensive Care and Toxicology Department, Deputy Head Doctor of Municipal Clinical Hospital no. 40
Russian Federation
Doctor of Medical Sciences, Professor, Head of Anesthesiology, Intensive Care and Toxicology Department, Deputy Head Doctor of Municipal Clinical Hospital no. 40
V. V. Kulabukhov
A. V. Vishnevsky Institute of Surgery, Moscow
Russian Federation
Candidate of Medical Sciences, Associate Professor
Russian Federation
Candidate of Medical Sciences, Associate Professor
References
1. Rudnov V.А., Kulabukhov V.V. Sepsis and teragnostics on the way to personal-ized medicine. Vestnik Anasteziol. i Reanimatol., 2015, no. 6, pp. 60-67. (In Russ.)
2. Rudnov V.А., Kulabukhov V.V. Evolving understanding of sepsis: the ongoing story. Infeksii v Khirurgii, 2015, no. 2, pp. 6-10. (In Russ.)
3. Sepsis v nachale XXI v. Klassifikatsiya, kliniko-diagnosticheskaya kontseptiya i lecheniye. Patologoanatomicheskaya diagnostika: prakticheskoye rukovodstvo. [Sepsis in the early XXI cen. Classification, clinical and diagnostic concept and treatment. Postmortem diagnostics: manual]. Moscow, NTSSH im. A.N. Bakuleva RAMN Publ., 2004, 130 p.
4. Angus D.C., van der Poll T. Severe sepsis and septic shock. N. Engl. J. Med., 2013, vol. 369, no. 9, pp. 840-851.
5. Bone R.C. Тoward an Epidemiology and Natural History of SIRS. JAMA, 1992, vol. 268, pp. 3452-3455.
6. Bone R.C. Sir Isaac Newton, sepsis, SIRS, and CARS. Crit. Care Med., 1996, vol. 245, pp. 1125-1128.
7. Bone R.С. Toward a theory regarding the pathogenesis of the systemic inflammatory response syndrome: what we do and do not know about cytokine regulation. Crit. Care Med., 1996, vol. 24, pp. 163-172.
8. Bone R.C. Immunologic dissonance: a continuing evolution in our understanding of the systemic inflammatory response syndrome and the multiple organ dysfunction syndrome. Crit. Care Med., 1996, vol. 125, no. 8, pp. 680-687.
9. Casserly B., Phillips G.S., Schorr C. et al. Lactate measurements in sepsis – induced tissue hypoperfusion: results from the Surviving Sepsis Campaign database. Crit. Care Med., 2015, vol. 43, no. 3, pp. 567-573.
10. Czura C.J. «Merinoff symposium 2010: sepsis» – speaking with one voice. Mol. Med., 2011, vol. 171, no. 1-2, pp. 2-3.
11. Deutschman C.S., Tracey K.J. Sepsis: current dogma and new Perspectives. Immunity, 2014, vol. 40, no. 4, pp. 463-475.
12. Hotchkiss R.S., Monneret G., Payen D. Sepsis-induced immunosuppression: from cellular dysfunctions to immunotherapy. Nat. Rev. Immunol., 2013, vol. 13, no. 12, pp. 862-874.
13. Iskander K.N., Osuchowski M.F., Stearns-Kurosawa D.J. et al. Sepsis: multiple abnormalities, heterogeneous responses and evolving understanding. Physiol. Rev., 2013, vol. 93, no. 3, pp. 1247-1288.
14. Kaukonen K.M., Bailey M., Pilcher D. et al. Systemic inflammatory response syndrome criteria in defining severe sepsis. N. Engl. J. M., 2015, vol. 372, no. 17, pp. 1629-1638.
15. Kwan A., Hubank M., Rashid A. et al. Transcriptional instability during evolving sepsis may limit biomarker based risk stratification. PLoS One, 2013, vol. 8, no. 3, pp. e60501.
16. Limjoco C. Sepsis now is severe sepsis. ICD – 10e news. http://www.icd10monitor.com/enews/item/1658–is–sepsis–now–severe–sepsis
17. Nathan C., Ding A. Nonresolving inflammation. Cell, 2010, vol. 140, pp. 871-882.
18. Seymour C.W., Liu V.X., Iwashyna T.J. et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 2016, vol. 315, no. 8, pp. 762-774.
19. Shankar-Hari M., Phillips G., Levy M. et al. Developing a new definition and assessing new clinical criteria for septic shock for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 2016, vol. 315, no. 8, pp. 775-787.
20. Singer M., Deuschman C.S., Seymour C.W. et al. The Third International Consensus definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 2016, vol. 315, no. 8, pp. 801-810.
21. Singer M., de Santis V., Vitale D. et al. Multiorgan failure is an adaptive, endocrinemediated, metabolic response to overwhelming systemic inflammation. Lancet, 2004, vol. 364 (9433), pp. 545-548.
22. Vincent J.L., Opal S.M., Marshall J.C. et al. Sepsis definitions: time for change. Lancet, 2013, vol. 381 (9868), pp. 774-775.
23. Wiersinga W.J., Leopold S.J., Cranendonk D.R. et al. Host innate immune responses to sepsis. Virulence, 2014, vol. 5, no. 1, pp. 36-44.
Review
For citations:
Rudnov V.A., Kulabukhov V.V. SEPSIS-3: UPDATED MAIN DEFINITIONS, POTENTIAL PROBLEMS AND NEXT PRACTICAL STEPS. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2016;13(4):4-11. (In Russ.) https://doi.org/10.21292/2078-5658-2016-13-4-4-11
Email this article 