**2.4 Etiology**

*Clinical Management of Shock - The Science and Art of Physiological Restoration*

• Sepsis is defined as life threatening organ dysfunction caused by dysregulated host responses to

• Organ dysfunction can be identified as an acute change if you have ≥2 points on the SOFA score in

• Baseline SOFA score can be assumed to be zero in patients with no preexisting organ dysfunction and a score of ≥2 reflects an overall mortality risk of approximately 10% in a general hospital population with

• Layman terms—sepsis is a life-threatening condition that arises when the body's response to an infec-

• Patients with suspected infection who are likely to have a prolonged ICU stay or to die in the hospital can be identified at the bedside with qSOFA (altered mental status, respiratory rate >22, systolic blood

• Septic shock is a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities

• Patients with septic shock have preexisting sepsis with persisting hypotension requiring vasopressors to maintain MAP ≥ 65 mmHg and having a serum lactate level >2 mmol/L despite adequate volume

*Abbreviations: MAP, mean arterial pressure; qSOFA, quick SOFA; SOFA, sequential [8] organ failure assessment;* 

are positive, the predictive validity is similar to the entire SOFA score when used

*Comparison of SIRS versus qSOFA [7, 13, 15]. Abbreviations: SIRS, systemic inflammatory response syndrome;* 

positive Respiratory Rate > 22 breaths/min

Temperature > 38.3°C or <36.0°C Heart rate > 90 beats/min

Respiratory rate > 20 breaths/min or PaCO2 < 32 mmHg White blood cell count < 4000 cells/mm3 or > 12,000 cells/mm3 Greater than 10% bandemia

Systolic blood pressure < 100 mmHg

Altered mental state/ Glasgow Coma Scale < 13

Sepsis is a clinical syndrome with an array of disease courses of which is not completely understood. It is characterized by a varied response to infection, started

**66**

**Figure 2.**

outside the ICU setting [14].

SIRS Criteria Must have 2 or more to meet positive criteria for SIRS

Sepsis-3 new terms and definitions

relation to an infection

suspected infection.

pressure <100 mmHg).

resuscitation.

*and ICU, intensive care unit.*

*Sepsis-3 terms and definitions [3, 6].*

**Table 1.**

tion injures its own tissues and organs.

are severe enough to increase mortality.

infection.

qSOFA Score Must have 2/3 to be considered

*SOFA, sequential organ failure assessment; and qSOFA, quick SOFA.*

**2.3 Pathophysiology**

Sepsis can be caused by any type of infecting organism and can originate from communities, hospitals or other health care facilities [2]. The most common culprit is pneumonia, which accounts for about half of all cases, followed closely by intra-abdominal infections and urinary tract infections [19]. The most common gram positive bacteria seen are *Staphylococcus aureus* and *Streptococcus pneumoniae*, whereas *Escherichia coli*, Klebsiella species, and *Pseudomonas aeruginosa* are the most common gram-negative bacteria seen [20].
