New sepsis guidelines
- The term severe sepsis is redundant.
- Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
- The clinical criterion for organ dysfunction is an increase in the SOFA (Sequential Organ Failure Assessment) score of 2 or more points, which has an associated in-hospital mortality exceeding 10%.
- Septic shock is a subset of sepsis with greater mortality risk than with sepsis alone because of particularly severe circulatory, cellular, and metabolic abnormalities.
- Clinical criteria for septic shock are the need for a vasopressor to maintain mean arterial pressure of 65 mm Hg or greater and a serum lactate level of more than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia.
- The combination of these 2 criteria predicts hospital mortality rates exceeding 40%.
- The task force defined a new bedside clinical score termed quick SOFA (qSOFA).
- The qSOFA score is used to assess just 3 symptoms in patients with suspected sepsis: altered mental status, fast respiratory rate and low blood pressure. Blood tests are not required. If patients with infection show two of the three criteria, they should be considered likely to be septic.