Sepsis - NYSORA

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Learning objectives

  • Definition of sepsis
  • Diagnostic features of sepsis
  • Management of sepsis

Definition and mechanisms

  • Sepsis is a dysregulated systemic response to infection that is associated with organ dysfunction
  • Quick sequential organ failure assessment (qSOFA) criteria:
    • Altered mental status (GCS score < 15)
    • Systolic blood pressure < 100 mmHg
    • Respiratory rate > 22 breaths per min
  • Septic shock is defined as low blood pressure due to sepsis that does not improve after fluid replacement
  • Characterized by high morbidity and mortality (30-50% of affected patients)
  • Septic patients are at risk for secondary injuries
  • Bacteria, fungi, and viruses can all cause sepsis

Signs and symptoms

  • Fever or hypothermia
  • Increased heart rate
  • Increased breathing rate
  • Confusion
  • Hypotension
  • Sweating
  • Edema
  • Low urine output

Risk factors

  • People older than 65 years old, newborns and infants, and pregnant people
  • Medical conditions such as diabetes, obesity, cancer, and kidney disease
  • A weakened immune system
  • People who are in the hospital for other medical reasons
  • Severe injuries, such as large burns or wounds
  • Patients with catheters, IVs, or breathing tubes

Diagnostic features

Organ system Alteration of dysfunction
Neurological Delirium
Altered mental status
Formation of blood clots in small blood vessels
Multifocal necrotizing leukoencephalopathy
Cardiac dysfunction
Systolic and diastolic dysfunction
Poor gas exchange
Acute Respiratory Distress Syndrome
Elevated plasma urea and creatinine
Volume overload
Disruption of blood clotting
Elevated unconjugated serum bilirubin levels
HematologicalPerioperative anemia
Disseminated Intravascular Coagulation (DIC)
Endocrine and metabolic
Sick euthyroid syndrome
Elevated lactate
Infectious disease
Elevated inflammatory mediators


  • Aggressive source control, resuscitation, and antibiotic therapy are the mainstays of management
  • Be aware of subtle changes such as hyperglycemia, ileus, mental status changes, and potential sources of infections

Sepsis, antibiotics, resuscitation, airway support, hydrocortisone, red cell transfusion, oxygen, ARDS, lung-protective ventilation, MAP, CVP, cardiac index, crystalloids, vasopressors, blood cultures

Anesthetic management

Sepsis, preoperative and postoperative assessment, antimicrobial, FFP, glycemic control, hydrocortisone

Intraoperative management of sepsis, induction, lactate, benzodiazepines, opioids, vasopressors, lung-protective ventilation, hypothermia, preoxygenate, succinylcholine, propofol, thiopental, etomidate, ketamine

Suggested reading

  • Ammar, M.A., Ammar, A.A., Wieruszewski, P.M. et al. Timing of vasoactive agents and corticosteroid initiation in septic shock. Ann. Intensive Care 12, 47 (2022).
  • Charlton, M., Thompson, J.P., 2019. Pharmacokinetics in sepsis. BJA Education 19, 7–13.
  • Gyawali B, Ramakrishna K, Dhamoon AS. Sepsis: The evolution in definition, pathophysiology, and management. SAGE Open Med. 2019;7:2050312119835043. 
  • Keeley A, Hine P, Nsutebu EThe recognition and management of sepsis and septic shock: a guide for non-intensivistsPostgraduate Medical Journal 2017;93:626-634.
  • Nunnally, M.E., 2016. Sepsis for the anaesthetist. British Journal of Anaesthesia 117, 44–51.
  • Eissa D, Carton EG, Buggy DJ. Anaesthetic management of patients with severe sepsis. Br J Anaesth. 2010;105(6):734-743.

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