Sandbox sepsis diagnostic criteria

# Overview
The 1992 statement from the ACCP/ SCCM Consensus Conference introduced into common parlance the Systemic Inflammatory Response Syndrome (SIRS) which represents the complex findings resulting from systemic activation of the innate immune response triggered by localized or generalized infection, trauma, thermal injury, or sterile inflammatory processes. However, criteria for SIRS are considered to be too nonspecific to be of utility in diagnosing a cause for the syndrome or in identifying a distinct pattern of host response. Sepsis is defined as the presence (probable or documented) of infection together with systemic manifestations of infection, whereas severe sepsis refers to sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusion. Septic shock is defined as sepsis-induced hypotension persisting despite adequate fluid resuscitation, in the absence of other causes for hypotension.

# Diagnostic Criteria

## Systemic Inflammatory Response Syndrome (SIRS)
The 1992 statement from the ACCP/ SCCM Consensus Conference introduced into common parlance the Systemic Inflammatory Response Syndrome (SIRS) which represents the complex findings resulting from systemic activation of the innate immune response triggered by localized or generalized infection, trauma, thermal injury, or sterile inflammatory processes. However, criteria for SIRS are considered to be too nonspecific to be of utility in diagnosing a cause for the syndrome or in identifying a distinct pattern of host response.

## Sepsis
Sepsis is defined as the presence (probable or documented) of infection together with systemic manifestations of infection. Diagnostic criteria for sepsis are as follows:

## Severe Sepsis
Severe sepsis is defined as sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusion.

## Septic Shock
Septic shock is defined as sepsis-induced hypotension persisting despite adequate fluid resuscitation, in the absence of other causes for hypotension.
- Septic shock in adults refers to a state of acute circulatory failure characterized by persistent arterial hypotension unexplained by other causes.
- Septic shock in pediatric patients is defined as a tachycardia (may be absent in the hypothermic patient) with signs of decreased perfusion including decreased peripheral pulses compared with central pulses, altered alertness, flash capillary refill or capillary refill 2 seconds, mottled or cool extremities, or decreased urine output.

## Refractory Septic Shock
Refractory Septic shock is defined as sepsis with refractory arterial hypotension and maintenance of the systemic mean blood pressure of >60 mmHg or >80 mmHg (in hypertensives) despite adequate fluid resuscitation requires:
- Dopamine >15 mcg/kg/min
- Norepinephrine >0.25 mcg/kg/min
- Epinephrine >0.25 mcg/kg/min
- Adequate fluid resuscitation is defined as infusion of the following at the said rates:
20 to 30 mL/kg of starch,
40 to 60 mL/kg of saline solution
Measured pulmonary capillary wedge pressure - 12 to 20 mmHg
Central venous pressure of 8 to 12 mmHg
- 20 to 30 mL/kg of starch,
- 40 to 60 mL/kg of saline solution
- Measured pulmonary capillary wedge pressure - 12 to 20 mmHg
- Central venous pressure of 8 to 12 mmHg

## Multiple Organ Dysfunction Syndrome
- It is defined as a progressive organ dysfunction that require interventions for maintenance of homeostasis.
- It is the most severe manifestation of either SIRS or sepsis continuum.
- Primary MODS can be directly connected to the source of infection. However, secondary MODS occurs as a result of host response to the primary insult.
- Parameters used to judge MODS are:
Liver - Serum bilirubin
Nervous system - Glasgow coma scale
Hematology - Platelet count
Renal - Serum creatinine
Respiratory - PO2/FiO2 ratio
Cardiovascular - Pressure-adjusted heart rate = Heart rate multiplied by the ratio of central venous pressure and mean arterial pressure
- Liver - Serum bilirubin
- Nervous system - Glasgow coma scale
- Hematology - Platelet count
- Renal - Serum creatinine
- Respiratory - PO2/FiO2 ratio
- Cardiovascular - Pressure-adjusted heart rate = Heart rate multiplied by the ratio of central venous pressure and mean arterial pressure

## Neonatal Sepsis
The criteria for diagnosing an adult with sepsis does not apply to infants under one month of age (neonatal sepsis). In infants, only the presence of infection plus a "constellation" of signs and symptoms consistent with the systemic response to infection are required for diagnosis.