Septic Shock

Abstract

The Septic Syndrome can be defined as hypothermics (T < 96°F rectal) or hyperthermia (T > 101°F rectal), tachycardia (> 90 bpm), tachypnea (> 20 bpm), a presumed site of infection, and evidence of inadequate perfusion as evidenced by either poor or altered cerebral function, arterial hypoxia (PaO>2 < 75 mm Hg) elevated plasma lactate level, or urine output less than 0.5 ml/kg body weight/hr without corrective therapy. Thirty-six patients with the Septic Syndrome were prospectively evaluated and found to have a 39% mortality rate. Forty-seven percent of the patients were found to be bacteremic and 64% manifested at least one episode of shock (systolic blood pressure < 90 mmHg or a decrease in systolic blood pressure > 40 mmHg that is sustained for at least one hour) during their hospitalization.

Survivors had a significantly lower mean age (48.8 ± 16.3 yrs vs. 59.8 ± 7.6 yrs X ± S.D.; p < 0.02) than the nonsurvivors. There was no significant difference in the incidence of bacteremia between survivors and nonsurvivors. Shock was present twice as often in nonsurvivors as in survivors (93% vs. 45%). Nonsurvivors had a higher initialplasma lactate level, and a greater degree of multi-organ failure as evidenced by an increased APACHE score (Acute Physiology and Chronic Health Evaluation) and an increased mean organ system dysfunction index.

These results indicate that the Septic Syndrome is associated with a significant mortality rate and the survival rates were not related to the presence or absence of bacteremia. The presence of shock and increased age were both associated with decreased survival rates. Nonsurvivors also exhibited a greater degree of multiorgan system dysfunction. The identification of the Septic Syndrome may allow for earlier treatment of patients with sepsis and potentially result in improved survival through prevention of shock and multiple organ system dysfunction.