(SYSTEMATIC INFLAMMATORY RESPONSE SYNDROME & MULTIPLE ORGAN

DYSFUNCTION SYNDROME)
Definition of Terms:

Infection: A microbial phenomenon characterized by an inflammatory response to the presence of

microorganisms or the invasion of normally sterile host tissue by those organisms.
Bacteremia: The presence of viable bacteria in the blood.
Systemic Inflammatory Response Syndrome (SIRS): The systemic inflammatory response to a
variety of severe clinical insults (For example, infection).
Sepsis: The systemic inflammatory response to infection.
Septic shock: serious medical condition that occurs when sepsis , which is organ injury or damage in
response to infection, leads to dangerously low blood pressure and abnormalities in cellular
metabolism.

Causes/Etiology:
The causes of SIRS are broadly classified as INFECTIOUS or NONINFECTIOUS.
......When SIRS is due to an infection, it is considered SEPSIS.
............Non-infectious causes of SIRS include trauma, burns, ischemia and haemorrhage.

SIRS-Sepsis-MODS Spectrum

Epidemiology suggests there is a general progression of pathologic states

SIRS
Sepsis
Severe Sepsis
Septic Shock
MODS

SIRS RESPONSE OF BODY TO STRESS also known as the CRITERIA:

Defined as 2 of the following:

Temperature abnormality >38C or <36C
Hemodynamic distress (PR) >90 bpm
Respiratory distress >20 bpm &/or >32mmol, or hypoxia <70%
Inflammatory marker (WBC ) >12k, <4k, or 10% band forms

Sepsis:
Known or suspected infection, plus
>2 SIRS Criteria.
Severe Sepsis:
Sepsis plus >1 organ dysfunction due to hypoperfusion
MODS.
 Septic Shock:
Definition: sepsis plus 1 of the following:

Decreased peripheral pulses (compared to central pulses)

capillary refill: >2 seconds
mottled or cool extremities (cold shock)
flash capillary refill (vasodilated / warm shock)
decreased urine output < 1 mL/kg/hr

MODS

Definition
progressive reversible dysfunction of 2 organs from acute disruption of normal homeostasis requiring
intervention
Primary MODS
immediate systemic response to injury or insult
Needs mostly<1 week in ICU, better prognosis,
Secondary MODS
progressive decompensation from host response & 2nd hits
Needs >1week in ICU, worse prognosis

PATHOPHYSIOLOGY:
 Signs & Symptoms

Since the ability of the body to provide oxygen and nutrients is interrupted, the heart compensates by
pumping faster (increase HR)
HYPOTENSION occurs because of vasodilation.
To compensate for the decreased oxygen concentration, the patient tends to breathe faster, and also
to eliminate more carbon dioxide from the body.
(increase RR) or (increase PaO2)
The inflammatory response is activated because of the invasion of pathogens. (increase WBC)
Decreased urine output. The body conserves water to avoid undergoing dehydration because of the
inflammatory process. (normal: 30 ml/hr)
Changes in mentation. As the body slowly becomes acidotic, the patients mental status also
deteriorates.

Level of consciousness: GCS checking

- Conscious (spontaneous - conscious & coherent to persons, place & time)

- Lethargic (respond only through verbal stimulation)
- Stupurous (respond only through pain stimulation)
- Obtunded (blank stare)
- Coma ( light & deep)

Elevated lactate level. The lactate level is elevated because there is maldistribution of blood.

CLINICAL MANIFESTATION FOR SEPTIC SHOCK:

Hemodynamic Alterations
Hyperdynamic State (Warm Shock)
Tachycardia.
Elevated or normal cardiac output.
Decreased systemic vascular resistance.
Hypodynamic State (Cold Shock)
Low cardiac output.

Organ Specific Manifestations

GI dysfunction
Hepatobiliary dysfunction
Pulmonary dysfunction
Renal dysfunction
Cardiovascular dysfunction
Coagulation system dysfunction
Hypoperfusion Ischemia of the gut Hypoperfusion Ischemia of the liver and gallbladder
Decreased peristalsis
Decreased integrity of ischemic hepatitis acalculous cholecystitis
the gut lining Colonization of
normal GI flora up
Translocation of normal into the orpharynx Jaundice Right upper pain and
GI bacteria into systemic tenderness
serum transaminase
circulation Abdominal distention
Aspiration of bacteria serum bilirubin
and initiation of a Unexplained fever
Systemic infection inflammatory response
Loss of bowel sounds
and SIRS in the lung

Initial response Late response

Hypoperfusion Ischemia of the Kidney
Myocardial depression Ventricular dilatation
And
Renal Function Right atrial pressure Diastolic
Renal toxic SVR compliance
drugs Venous capacitance contractile
Azotemia VO2
function
CO
Creatinine clearance CO
Ability to maintain
HR
Fluid and electrolyte BP without
imbalances vasopressors
Fluid volume overload

The lungs are usually the first organ affected

in secondary MODS.
Failure of the coagulation system is
manifested as DIC.
Pulmonary dysfunction manifest as ARDS.
Results in simultaneous microvascular
clotting and hemorrhage in organ systems
ARDS generally presents 24-48 hours after because of the depletion of clotting factors.
the initial injury.
Nursing Collaborative Management

PREVENTION:

The best management is prevention

The principle are

decrease the severity of the risk factor

Lessen the inflammation
Appropriate resuscitation and control of infection
Avoid unsuitable operation and use of antibiotic
Treat the dysfunction organ and malnutrition

Strict infection control practices. To prevent the invasion of microorganisms inside the body, infection
must be put at bay through effective aseptic techniques and interventions.

Prevent central line infections. Hospitals must implement efficient programs to prevent central line
infections, which is the most dangerous route that can be involved in sepsis.

Early debriding of wounds. Wounds should be debrided early so that necrotic tissue would be
removed.

Equipment cleanliness. Equipment used for the patient, especially the ones involved in invasive
procedures, must be properly cleaned and maintained to avoid harboring harmful microorganisms
that can enter the body.

ASSESSMENT &Dx examination:

Early assessment and diagnosis of the infection must be established to avoid its progression.

Blood culture. To identify the microorganism responsible for the disease, a blood culture must be
performed.

Liver function test. This should be performed to detect any alteration in the function of the liver.

Blood studies. Hematologic test must also be performed to check on the perfusion of the blood.

MEDICAL MGT:

The current treatment of SEPTIC SHOCK and sepsis include identification and elimination of the cause of
infection.

Fluid replacement therapy. The therapy is done to correct the tissue hypoperfusion, so aggressive
fluid resuscitation must be implemented.

Pharmacologic therapy. Drotrecogin alfa is used to act as antithrombotic, anti-inflammatory, and

profibrinolytic agent.
 Nutritional therapy. Aggressive nutritional supplementation is critical in the management of septic
shock because malnutrition further impairs the patients resistance to infection.

NURSING MANAGEMENT:

Infection control. All invasive procedures must be carried out with aseptic technique after
careful hand hygiene.

Collaboration. The nurse must collaborate with the other members of the healthcare team to identify
the site and source of sepsis and specific organisms involved.

Management of fever: The nurse must monitor the patient closely for shivering.

Pharmacologic therapy. The nurse should administer prescribed IV fluids and medications
including a antibiotic agents and vasoactive medications.

Monitor blood levels. The nurse must monitor antibiotic toxicity, BUN, creatinine, WBC, hemoglobin,
hematocrit, platelet levels, and coagulation studies.

Assess physiologic status. The nurse should assess the patients hemodynamic status, fluid intake and
output, and nutritional status.

Reported by: SILAO, Sr. Nerlyn