[Artigo] Sepsis
Sepsis
TERMINOLOGY
CLINICAL CLARIFICATION
- Sepsis is a life-threatening syndrome of organ dysfunction caused by microbial infection in conjunction with a
dysregulated host response - Characterized by a cascade of endothelial damage, vascular permeability, microvascular dysfunction, and coagulopathies, which can lead to multiorgan failure and death if not treated promptly and adequately or if not responsive to treatment
CLASSIFICATION
- Sepsis
○ Life-threatening organ dysfunction caused by dysregulated host response to infection
○ Organ dysfunction is defined by increase from baseline in SOFA score of 2 or more (Sequential Organ Failure Assessment; originally the Sepsis-Related Organ Failure Assessment) - Septic shock 1
○ Subset of sepsis with profound circulatory and cellular/metabolic dysfunction and with significantly greater mortality risk
○ Defined as need for administration of vasopressor medication to maintain mean arterial pressure of at least 65 mm Hg and serum lactate level more than 2 mmol/L in the absence of hypovolemia
DIAGNOSIS
CLINICAL PRESENTATION
- History
○ Presentation is variable, depending on causative agent and portal of entry
○ Low threshold of suspicion and early recognition of sepsis are essential for successful outcomes
○ Thorough and timely history focuses on symptoms, comorbidities, recent surgery, recent antibiotic use, presence of
medical devices, and travel
○ Common generalized symptoms of sepsis include:
– Fever, chills; rigors may be reported
– Confusion, anxiety
– Fatigue, malaise
– Myalgia
– Dyspnea
– Nausea and vomiting
– Decreased urination
○ Localizing symptoms may include:
– Headache and stiff neck when meningitis is the cause of sepsis
– Cough and pleuritic chest pain with pneumonia
– Abdominal pain with gastrointestinal or genitourinary source
– Diarrhea in gastrointestinal luminal infections, such as Clostridium difficile or toxigenic Escherichia coli infection
– Flank pain and dysuria with kidney infection
– Bone or joint pain with osteomyelitis or septic arthritis
– Skin or soft tissue pain with abscesses, wounds, or other soft tissue infections
○ Elderly persons may have limited or nonspecific symptoms (eg, poor oral intake, inanition)
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