Systemic inflammatory response syndrome
| Systemic inflammatory response syndrome | |
|---|---|
multiple organ failure | |
In
Presentation
Complications
SIRS is frequently complicated by failure of one or more organs or organ systems.[2][3][4] The complications of SIRS include
Causes
The causes of SIRS are broadly classified as infectious or noninfectious. Causes of SIRS include:[citation needed]
- bacterial infections
- severe malaria
- trauma
- burns
- pancreatitis
- ischemia
- hemorrhage
Other causes include:[2][3][4]
- Complications of surgery
- Adrenal insufficiency
- Pulmonary embolism
- Complicated aortic aneurysm
- Cardiac tamponade
- Anaphylaxis
- Drug overdose
Diagnosis
| Finding | Value |
|---|---|
Temperature |
<36 °C (96.8 °F) or >38 °C (100.4 °F) |
| Heart rate | >90/min |
| Respiratory rate | >20/min or PaCO2 <32 mmHg (4.3 kPa)
|
WBC |
<4x109/L (<4000/mm3), >12x109/L (>12,000/mm3), or ≥10% bands
|
SIRS is a serious condition related to systemic inflammation, organ dysfunction, and organ failure. It is a subset of cytokine storm, in which there is abnormal regulation of various cytokines.[6] SIRS is also closely related to sepsis, in which patients satisfy criteria for SIRS and have a suspected or proven infection.[2][3][4][7]
Many experts consider the current criteria for a SIRS diagnosis to be overly sensitive, as nearly all (>90%) of patients admitted to the ICU meet the SIRS criteria.[8]
Adult
Manifestations of SIRS include, but are not limited to:[9]
- Body temperatureless than 36 °C (96.8 °F) or greater than 38 °C (100.4 °F)
- Heart rate greater than 90 beats per minute
- Tachypnea (high respiratory rate), with greater than 20 breaths per minute; or, an arterial partial pressure of carbon dioxide less than 4.3 kPa (32 mmHg)
- immature neutrophils (band forms). Band forms greater than 3% is called bandemiaor a "left-shift".
When two or more of these criteria are met with or without evidence of infection, patients may be diagnosed with "SIRS". Patients with SIRS and acute organ dysfunction may be termed "severe SIRS".
Children
The International Pediatric Sepsis Consensus has proposed some changes to adapt these criteria to the pediatric population.[11]
In children, the SIRS criteria are modified in the following fashion:[11]
- congenital heart diseaseor unexplained persistent depression for greater than 30 minutes.
- Body temperature obtained orally, rectally, from Foley catheter probe, or from central venous catheterprobe less than 36 °C or greater than 38.5 °C.
- standard deviations above normal for age or the requirement for mechanical ventilation not related to neuromuscular disease or the administration of anesthesia.
- White blood cell count elevated or depressed for age not related to chemotherapy, or greater than 10% bands plus other immature forms.
Temperature or white blood cell count must be abnormal to qualify as SIRS in pediatric patients.[11]
Treatment
Generally, the treatment for SIRS is directed towards the underlying problem or inciting cause (i.e. adequate fluid replacement for hypovolemia, IVF/
Septic treatment protocol and diagnostic tools have been created due to the potentially severe outcome septic shock. For example, the SIRS criteria were created as mentioned above to be extremely sensitive in suggesting which patients may have sepsis. However, these rules lack specificity, i.e. not a true diagnosis of the condition, but rather a suggestion to take necessary precautions. The SIRS criteria are guidelines set in place to ensure septic patients receive care as early as possible.[5]
In cases caused by an implanted mesh, removal (explantation) of the polypropylene surgical mesh implant may be indicated.[16]
History
The concept of SIRS was first conceived of and presented by William R. Nelson, of the Department of Surgery of the University of Toronto. SIRS was more broadly adopted in 1991 at the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference with the goal of aiding in the early detection of sepsis.[17]
Criteria for SIRS were established in 1992 as part of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference.[2] The conference concluded that the manifestations of SIRS include, but are not limited to the first four described above under adult SIRS criteria.[citation needed]
In septic patients, these clinical signs can also be seen in other proinflammatory conditions, such as trauma, burns, pancreatitis, etc. A follow-up conference, therefore, decided to define the patients with a documented or highly suspicious infection that results in a systemic inflammatory response as having sepsis.[18] Note that SIRS criteria are non-specific,[18] and must be interpreted carefully within the clinical context. These criteria exist primarily for the purpose of more objectively classifying critically ill patients so that future clinical studies may be more rigorous and more easily reproducible.[citation needed]
References
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- ^ S2CID 20057097. Archived from the original(PDF) on 2013-10-17.
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- ^ ISBN 0-683-05565-8.
- ^ PMID 1303622.
- S2CID 206624494. Archived from the original(PDF) on 2016-03-03. Retrieved 2011-04-04.
- ^ Kalil A (2020-10-07). "Septic Shock". Medscape.updated
- PMID 25390327.
- PMID 20035633.
- PMID 15735579.
- ^ S2CID 8190072.
- ^ Boka K (2019-06-26). "Systemic Inflammatory Response Syndrome Treatment & Management". Medscape.
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- ^ "CHEST Home".
- ^ S2CID 19605781.