Wikipedia:VideoWiki/Sepsis

Definition
Sepsis is a life-threatening condition, that arises when the body's response to infection causes injury to its own tissues and organs.

Symptoms
Common signs and symptoms include fever, increased heart rate, increased breathing rate, and confusion.

More specific symptoms
There may also be symptoms related to a specific infection, such as a cough with pneumonia, or painful urination with a kidney infection.

Young and old
In the very young, old, and people with a weakened immune systems, there may be no symptoms of a specific infection. The body temperature can also be low or normal, rather than high.

Symptoms of severe sepsis
Severe sepsis, is sepsis that is causing poor organ function, or insufficient blood flow to the body. Insufficient blood flow can manifest as either low blood pressure, high blood lactate, or low urine output.

Septic shock
Septic shock is low blood pressure due to sepsis, that does not improve after fluid replacement.

Causes
Sepsis is caused by an inflammatory immune response, triggered by an infection.

Microbiology
Most commonly, the infection is bacterial, but it may also be fungal, viral, or protozoan. Common locations for the primary infection include the lungs, brain, urinary tract, skin, and abdominal organs.

Risk factors
Risk factors include very young age, older age, and a weakened immune system from conditions such as cancer, diabetes, major trauma, or burns.

Diagnosis
An older method of diagnosis was based on the patient meeting at least two criteria from the systemic inflammatory response syndrome (called SIRS), because of a presumed infection.

Modern diagnosis
In 2016, SIRS was replaced with a shortened sequential organ failure assessment score (called the SOFA score). With the quick SOFA, if the patient has any two of, increased breathing rate, change in their level of consciousness, or low blood pressure, then they meet the criteria.

Blood cultures
Blood cultures are recommended, preferably, before antibiotics are started, however, proof of infection in the blood is not required for the diagnosis.

Medical imaging
Medical imaging should be used to look for the possible location of infection.

Differential diagnosis
Other potential causes of similar signs and symptoms include, anaphylaxis, adrenal insufficiency, low blood volume, heart failure, and pulmonary embolism.

Treatment
Sepsis is usually treated with intravenous fluids, and antibiotics.

Antibiotics
Typically, antibiotics are given as soon as possible, with high level care such as in an intensive care unit.

Fluid replacement and blood pressure
If fluid replacement is not enough to maintain blood pressure, medications that raise blood pressure may be used. Mechanical ventilation and dialysis may be needed, to support the function of the lungs and kidneys.

Monitoring blood pressure
To guide treatment, a central venous catheter, and an arterial catheter may be placed for access to the bloodstream. Other measurements such as cardiac output, and superior vena cava oxygen saturation may be used.

Risks of sepsis
People with sepsis need preventive measures for deep vein thrombosis, stress ulcers and pressure ulcers, unless other conditions prevent such interventions. Some might benefit from tight control of blood sugar levels with insulin.

Steroid use
The use of corticosteroids is controversial. Although, a 2015 Cochrane review found low-quality evidence of benefit, as did a 2019 review in JAMA.

Prognosis
Disease severity partly determines the outcome. The risk of death from sepsis is as high as 30%, from severe sepsis as high as 50%, and from septic shock as high as 80%.

Epidemiology
Millions are affected by sepsis each year, with a rate of 0.2-3 people per thousand, per year in the developed world. But the global burden of disease is unknown since little data exists from the developing world.

Change in rate of disease
It is believed that rates of disease have been increasing, and that sepsis is more common among males than females.

History
The medical condition has been described since the time of Hippocrates. The terms "septicemia" and "blood poisoning" have been used in various ways, and are no longer recommended.