Sepsis, Severe Sepsis, and Septic Shock

Incidence of sepsis within USA: Approximately 1 million per year and increasing. Severe sepsis and septic shock are associated with high morbidity and mortality, and septic shock is the most common cause of death among critically ill pts in noncoronary ICUs.

Although in-hospital mortality rates are very high, they have been declining. With prompt and appropriate treatment, approximate mortality from septic shock is 20–30%.

Increased prevalence with advanced age, male gender, nonwhite ethnic origin, comorbid diseases (COPD, cancer, chronic renal and liver disease, DM).

Hemodynamic and respiratory instability

Thrombocytopenia and DIC

End-organ ischemia and worsening multisystem organ dysfunction

Rapid hemodynamic deterioration following induction of anesthesia secondary to limited physiologic reserve

Blunted response to vasopressors and inotropes

Early and appropriate initiation of antibiotics

Multidrug-resistant bacteria (in up to 25% of cases of severe sepsis and septic shock)

Multisystem organ failure (mortality increases with each successive organ failure)