SIRS

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SIRS MODS

• Cindy Fehr
• Malaspina University-College
• BSN Nursing Program
• Nursing 335 Fall 2005

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Inflammation

• Inflammation is immediate response to cellular
  injury
• Triggered response to variety of causes
• Ischemia, infection, trauma, foreign substances,
  malignancies
• Limited to specific area ? localized inflammation
• Large number or persistent inflammatory mediators
  released ? generalized systemic inflammatory
  response ? SIRS

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SIRS

• Systemic Inflammatory Response Syndrome
• Common causes
• Massive trauma, burns, pancreatitis, septic shock
• Characterized by presence of any 2 of the
  following clinical findings in response to tissue
  injury
• Temp gt 38C or lt 36C
• HR gt 90
• RR gt 20 or respiratory alkalosis
• WBC gt 12,000 or lt 4,000 cells/mm3 or gt 10
  immature WBCs (bands)
• Can lead to altered circulation coagulation
  edothelial dysfunction impaired tissue perfusion

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SEPSIS

• Syndrome on continuum
• When pt has findings of SIRS, PLUS, they have an
  infection
• Also known as a widespread inflammatory response
  caused by infection

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SEPSIS cont.

• Systemic Inflammation Characteristics
• Vasodilation of BV ? hypotension
• leaky capillaries ? ? bld circulating volume ?
  worsening hypotension
• ? metabolic rate
• ? microscopic clotting
• Persistence of these responses can lead to
  impaired blood flow to organs ? organ dysfunction
• Clinical Signs Symptoms
• Chills - hypotension
• ? skin perfusion - ? u/o
• Significant edema or fluid balance
• ? cap refill or mottling
• Hyperglycemia in absence of diabetes
• Unexplained change in mental status

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Multisystem Effects of Shock
Source Hogan, M. A. Hill, K. (2004).
Pathophysiology reviews and rationales. Upper
Saddle River, New Jersey Prentice Hall.
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SEPSIS cont.

• Severe Sepsis
• Sepsis associated with NEW organ dysfunction (1
  or more organ systems), hypotension or
  hypoperfusion
• Septic Shock
• When organ failure in severe sepsis worsens and
  no longer responds to fluid administration
  (persistent arterial hypotension) vasoactive
  drugs required to constrict BV

Organ Dysfunction Hypoperfusion
O2 defect Creatinine ? Coagulation abnormalities Thrombocytopenia Hyperbilirubinemia Ileus Acute oliguria High lactate Decreased capillary refill or mottling
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Source Cheek, D.J., McGehee-Smith, H., Cunneen,
J., Cartwright, M. (2005). Sepsis Taking a
deeper look. Nursing 2005, 35(1), 38-42
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Signs Symptoms of Organ Failure
Source Kleinpell, R.M. (2005). Working out the
complexities of severe sepsis, The Nurse
Practitioner, 30(4), 43-48
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MODS

• Multiple Organ Dysfunction Syndrome
• Also known as Multiple Organ System Failure or
  Mulitsystem Organ Failure
• Often associated with sepsis and may affect any
  organ
• Respiratory, Cardiovascular and Renal systems
  most often affected
• Major cause of sepsis-related deaths
• Can happen in matter of hours or progress over
  days or weeks
• 10 MODS direct result of well-defined insult in
  which organ dysfunction occurs early and is
  directly attributable to the insult itself
• 20 MODS develops as a consequence of a host
  response (SIRS related)

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Mediator Responses to Body Insult

• Stimulation of SNS fight or flight
• Damage to endothelial lining of BVs
• Activation of inflammatory/immune response

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Pathophysiology of Multisystem Organ Failure
Source Huddleston, V. B. (1991). Multisystem
organ failure. Nursing 1991, September, 34-41.
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Treatment Focus

• Aggressive treatment of underlying infection
• antibiotics
• Fluids
• Crystalloids (NS, LR) Colloids (hetastarch
  PRBC)
• Inotropic drugs vasopressors to increase tissue
  perfusion
• Inotropes (Dobutamine) ? boost strength of heart
  contractions
• Vasopressors (Norepinephrine, epinephrine,
  phenylephrine, vasopressin or dopamine) ? support
  BP via vasoconstriction
• Targeted organ system support
• Mechanical ventilation, hemodialysis, tight
  glycemic control, steroids for adrenal
  insufficient
• Activate Protein C
• ? inflammation coagulation, restore
  fibrinolysis
• SE ? risk of bleeding

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• MODS difficult to reverse
• Prevention is the key
• Recognize hypoperfusion inflammatory response
  put at large risk after significant damage
• Normal physiologic processes that get out of
  hand to unchecked can lead to MODS
• Track trends stay alert for subtle changes that
  can lead to devastating spiral into MODS
• Aggressive treatment when first deterioration
  noted
• Collaborative work from all health team members