Shock Syndromes I

Sepsis is caused by a dysregulated host response to infection.

source of infection with two or more criteria of the systemic inflammatory response syndrome. Sepsis

was further classified as sepsis, severe sepsis (sepsis with organ dysfunction), or septic shock (sepsis

with arterial hypotension unresponsive to fluid administration).

of patients with sepsis and septic shock. The 2021 SSC guidelines were sponsored or endorsed by 24

international organizations and inform many of the recommendations in this section.

infection.

Organ dysfunction can be identified as an acute change in the total SOFA score of 2 points or higher

consequent to the infection.

A prompt identification tool (“qSOFA”) for bedside use outside the ICU was also proposed in 2016,

which includes altered mental status, SBP of 100 mm Hg or less, and respiratory rate of 22 breaths/

minute or greater. Fulfillment of two of these three criteria had predictive validity for mortality similar

to the full SOFA score outside the ICU (technically, a Glasgow Coma Scale score of 13 or less was used

in the regression model but was simplified to any alteration in mental status for the qSOFA).

Of importance, qSOFA does not define sepsis, but two or more qSOFA criteria are a predictor of

both increased mortality and ICU stays of more than 3 days in non-ICU patients. These criteria

should also be used to investigate further for infection.

The full SOFA score is superior to the qSOFA for predicting mortality in patients in the ICU.

Emerging data analyses suggest that in patients outside the ICU, the qSOFA score has a lower

discriminant ability for predicting ICU admission or death than other early warning scores (NEWS

or MEWS) and should be further investigated before implementation as a risk-stratification tool for

patients with suspected infection.

against using qSOFA as a single screening tool for sepsis or septic shock.

Septic shock is defined as a subset of sepsis in which underlying circulatory and cellular/metabolic

abnormalities are sufficient to increase mortality substantially.

Patients with septic shock can be identified as those with sepsis with persistent hypotension requiring

vasopressors to maintain a MAP of 65 mm Hg and greater and having a serum lactate concentration

greater than 2 mmol/L despite adequate fluid resuscitation.

With this new definition, the systemic inflammatory response syndrome criteria are no longer used, and

severe sepsis no longer exists as a clinical entity.

The new sepsis definition better identifies patients at risk of in-hospital mortality secondary to sepsis

(about 10% mortality) than the previous definition.

These definitions will likely shift patient identification and terminology in clinical practice, particularly

for patient inclusion in studies.

website (www.survivingsepsis.org). This website also contains the most up-to-date recommendations,

tools for implementation, and official statements from the campaign regarding ongoing events (e.g., the

new sepsis definitions).