Sepsis and Septic Shock Redefined

In late February 2016 the Society of Critical Care Medicine released a new document about Sepsis-3, otherwise known as the Third International Consensus Definitions of Sepsis and Septic Shock. Sepsis continues to be a leading cause of mortality and ICU admission. As members of the healthcare team we are constantly striving to improve the prompt identification and treatment of Sepsis. In recent research it has been revealed that criteria used previously to predict mortality for sepsis has been lacking. Most healthcare providers already knew this. The Systemic Inflammatory Response (SIRS) Criteria has been widely used to screen and identify patients with Sepsis. Under these definitions patients with 2 or more findings in this Criteria were further classified into a 3 tier system consisting of:

Sepsis, if there is a suspected infection source

Severe Sepsis, if the patient meets the criteria for sepsis and has signs of either end organ damage, elevated lactate or hypotension

Septic Shock, if the patient meets the Severe Sepsis criteria and despite fluid resuscitation continues to be hypotensive

Healthcare workers, especially those who work in Critical Care and Rapid Response, are familiar with these criteria.

This new document identifies sepsis as a "life threatening organ dysfunction caused by a dysregulated host response to infection". Sequential Organ Failure Assessment (SOFA) is the new tool proposed to quantify organ dysfunction. Understanding that the baseline SOFA score is zero in patients without pre-existing organ dysfunction, a change in the SOFA score of 2 points can determine that organ dysfunction is present. A quick tool to identify patients at risk of mortality or who may require an ICU admission is a quick SOFA (qSOFA).

Quick SOFA (qSOFA) Criteria consists of:

Respiratory rate greater than or equal to 22 per minute

Systolic blood pressure less than or equal to 100 mm Hg

Altered mental activity

Septic Shock is defined as a "subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality. Patients with septic shock can be identified with a clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP greater than or equal to 65 mm HG and having a serum lactate level greater than 2 mmol/L (18mg/dL) despite adequate volume resuscitation" (Singer et al, 2016).

An overhaul of the system of sepsis monitoring is likely under these new definitions and using these new tools. This may require new forms to reflect new methods for sepsis screening. 

Author: Mary Crawford, HealthCare Employment Network