The definition of septic shock: Implications for treatment

Marik, Paul E. and Lipman, Jeffrey (2007) The definition of septic shock: Implications for treatment. Critical Care and Resuscitation, 9 1: 101-103.

Author Marik, Paul E.
Lipman, Jeffrey
Title The definition of septic shock: Implications for treatment
Journal name Critical Care and Resuscitation   Check publisher's open access policy
ISSN 1441-2772
Publication date 2007-03-01
Sub-type Article (original research)
Volume 9
Issue 1
Start page 101
End page 103
Total pages 3
Place of publication Melbourne, Australia
Publisher Australasian Academy of Critical Care Medicine
Language eng
Abstract Sepsis is among the most common reasons for admission to intensive care units throughout the world. In 1991, a new set of terms and definitions was developed to define sepsis more precisely. The concept of the 'systemic inflammatory response syndrome' (SIRS) was developed, and its diagnostic criteria were defined. Sepsis was defined as suspected or microbiologically proven infection together with SIRS, while severe sepsis was defined as sepsis together with sepsis-induced organ dysfunction. Septic shock was defined as sepsis-induced hypotension persisting despite adequate fluid resuscitation. Data from recently published trials support this hierarchical stratification, with the mortality from sepsis ranging from 10% to 15%, severe sepsis from 17% to 20%, and septic shock from 43% to 54%. The distinction between severe sepsis and septic shock is critically important as it stratifies patients into groups with a low and a high risk of dying, respectively. However, currently the diagnostic criteria of septic shock remain vague. We suggest that septic shock is best defined by a systolic blood pressure less than 90 mmHg (or a fall in systolic blood pressure of > 40 mmHg), or a mean arterial pressure less than 65 mmHg after a crystalloid fluid challenge of 30 mL per kg body weight in a patient with severe sepsis. We believe that a vasopressor should be initiated in patients who remain hypotensive after this fluid challenge. The above operational definition of septic shock is important, as it clearly and unambiguously defines in which patients, and when, treatment with a vasopressor should be initiated, and in which patients adjunctive therapy with hydrocortisone and drotrecogin alfa (activated) should be considered.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
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Created: Thu, 19 Mar 2009, 20:59:04 EST by Ms Karen Naughton on behalf of Anaesthesiology and Critical Care - RBWH