Septic Shock (Sepsis) | Pathophysiology and Nursing Interventions

Summary

Sepsis is a severe systemic infection that begins with bacterial invasion and can lead to multiple organ failure. It results from a dysregulated immune response following a breach in the body's defenses, causing widespread inflammation, blood clotting, low blood pressure, and poor tissue perfusion. Risk factors include infections, wounds, hospitalizations, immune deficiencies, and chronic diseases. Symptoms range from fever and malaise to hypotension, tachycardia, and organ dysfunction. Sepsis progresses through stages, from infection to systemic inflammatory response syndrome (SIRS), severe sepsis, septic shock, and ultimately, multiple organ dysfunction syndrome (MODS), which can lead to death if untreated.

Takeaways

• 🦠 Sepsis is a systemic infection that can lead to multiple organ failure, starting with bacterial invasion.
• 🩸 Sepsis involves a breach in the host's skin or mucous membranes, leading to a dysregulated immune response.
• 🧬 Inflammatory mediators cause vasodilation, increased capillary permeability, and low blood pressure (hypotension).
• 🧪 The immune response triggers the coagulation cascade and leads to clotting in blood vessels, resulting in poor tissue perfusion and damage.
• 🚨 Risk factors for sepsis include wounds, infections, ICU admission, immune system deficiencies, surgeries, indwelling medical devices, and extremes of age.
• ⚠️ Early signs of sepsis are non-specific, including malaise, fever, hypotension, tachycardia, edema, and hypoxemia.
• 🔬 Lab results show increased white blood cell count, inflammatory markers, serum lactate, and markers of organ damage, with positive blood cultures.
• 💉 Sepsis occurs on a continuum, starting with infection and potentially progressing to systemic inflammatory response syndrome (SIRS), then severe sepsis, septic shock, and multiple organ dysfunction syndrome (MODS).
• 📊 SIRS is diagnosed when two or more criteria are met (e.g., abnormal temperature, heart rate, respiratory rate, or white blood cell count).
• 💀 If untreated, sepsis can result in multiple organ dysfunction and death, with symptoms like respiratory failure, liver and kidney impairment, and cardiac arrest.

Q & A

What is sepsis?

Sepsis is a continuum of systemic or widespread infection in the bloodstream that starts with bacterial invasion and can lead to multiple organ failure. It is characterized by a dysregulated immune response in the host.

How does sepsis begin?

Sepsis often begins with a breach in the host's barrier, such as the skin or mucous membranes, which triggers a dysregulated immune response. This response involves inflammatory mediators, vasodilation, increased capillary permeability, and activation of the coagulation and complement cascades.

What are some common risk factors for sepsis?

Risk factors for sepsis include wounds (pressure injuries, traumatic wounds, chronic non-healing wounds), infections (such as kidney or lung infections), hospital or ICU admission, immune system deficiencies (HIV, cancer), recent surgeries, indwelling medical devices (central lines, urinary catheters), very young or old age, chronic disease, and genetics.

What are the early symptoms of sepsis?

Early symptoms of sepsis include general, non-specific signs such as malaise and fever. As sepsis progresses, hypotension and tachycardia may develop due to vasodilation and increased capillary permeability.

How does the immune response in sepsis lead to tissue damage?

In sepsis, the immune system releases pro-inflammatory mediators that cause detrimental effects such as clotting in the blood vessels. This clotting blocks blood flow, leading to poor tissue perfusion and tissue damage.

What laboratory markers are elevated in sepsis?

Laboratory markers in sepsis include an increased white blood cell count (with immature white blood cells indicating a left shift), increased inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate, and markers of hypoperfusion such as elevated serum lactate.

What are the clinical manifestations of sepsis as it progresses?

As sepsis progresses, clinical manifestations include hypotension, tachycardia, edema, tachypnea, hypoxemia, and low urine output due to poor perfusion and kidney damage. Signs of organ damage such as increased creatinine and bilirubin levels may also be seen.

What is Systemic Inflammatory Response Syndrome (SIRS), and how is it related to sepsis?

SIRS is a widespread inflammatory reaction that can occur as a response to infection or other inflammatory causes. Sepsis is diagnosed when SIRS criteria are met, and there is a diagnosed source of infection. SIRS involves two or more symptoms, including abnormal temperature, heart rate, respiratory rate, and white blood cell count.

What differentiates severe sepsis from septic shock?

Severe sepsis is characterized by hypotension or hypoperfusion, leading to lactic acidosis and organ dysfunction. Septic shock occurs when hypotension persists despite adequate fluid resuscitation, indicating more severe circulatory failure.

What is Multiple Organ Dysfunction Syndrome (MODS), and how is it related to sepsis?

MODS occurs when septic shock leads to the failure of two or more organs, such as respiratory failure, liver impairment, kidney impairment, neurological impairment, and cardiac impairment. If left untreated, MODS can result in death.

Outlines

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🦠 Overview of Sepsis and its Progression

Sepsis is a severe and widespread infection that enters the bloodstream, which can lead to multiple organ failure if untreated. It begins with bacterial invasion, causing the immune system to become dysregulated. This results in vasodilation, capillary permeability, and activation of the coagulation and complement cascades. These immune responses can cause blood clots, poor tissue perfusion, and ultimately tissue damage. Risk factors include open wounds, infections like kidney or lung infections, hospital stays, immune deficiencies (HIV, cancer), recent surgeries, use of indwelling medical devices, extreme ages, chronic diseases, or genetics.

🌡️ Clinical Manifestations and Symptoms of Sepsis

The clinical signs of sepsis begin with non-specific symptoms such as malaise and fever. As the condition progresses, patients may experience hypotension, tachycardia, edema, tachypnea, and hypoxemia due to tissue damage and poor perfusion. Urine output may decrease, and lab results will show increased white blood cell counts with immature cells, higher inflammatory markers, markers of tissue damage, and positive blood cultures. Impaired coagulation is evident through increased bleeding times and abnormal platelet counts.

🔄 The Continuum of Sepsis: From Infection to MODS

Sepsis progresses along a continuum, beginning with a localized infection and potentially ending in multiple organ dysfunction syndrome (MODS) or death. Initially, localized inflammation occurs. If untreated, it can lead to a systemic inflammatory response syndrome (SIRS), characterized by symptoms such as abnormal temperature, heart rate, and white blood cell count. Sepsis is diagnosed when an infection source is identified, along with SIRS criteria. Severe sepsis involves hypotension and hypoperfusion, indicated by lactic acidosis and low blood pressure, progressing to septic shock if unresponsive to fluids.

🚨 Septic Shock and MODS

Septic shock is defined by persistent hypotension despite fluid resuscitation. This occurs when the body can no longer maintain adequate blood pressure after receiving treatment, indicating the severity of the condition. If septic shock continues, multiple organ dysfunction syndrome (MODS) may develop, where at least two organ systems begin to fail, such as respiratory failure, liver dysfunction, kidney impairment, and neurological decline. Without timely intervention, MODS can lead to death.

Keywords

💡Sepsis

Sepsis is a life-threatening condition that occurs when the body's response to an infection triggers a chain reaction of inflammation, leading to widespread tissue damage. In the video, sepsis is described as a continuum that can escalate from a localized infection to systemic organ failure, highlighting the danger of untreated infections.

💡Systemic Inflammatory Response Syndrome (SIRS)

SIRS is a severe inflammatory response that can occur with or without an infection. It is diagnosed when two or more criteria like abnormal body temperature, heart rate, or white blood cell count are met. In the video, SIRS is mentioned as an early stage in the sepsis continuum that can progress to more severe conditions if untreated.

💡Vasodilation

Vasodilation refers to the widening of blood vessels, which occurs as a result of inflammatory mediators released during sepsis. This leads to a drop in blood pressure, or hypotension, as described in the video. This process is critical because it affects blood flow and oxygen delivery to tissues, contributing to the deterioration seen in sepsis.

💡Capillary Permeability

Increased capillary permeability occurs when the small blood vessels allow more fluid to pass through, leading to swelling (edema) and low blood pressure. The video explains how this process, triggered by inflammation in sepsis, results in poor tissue perfusion and tissue damage, key contributors to organ failure.

💡Hypotension

Hypotension, or low blood pressure, is a critical sign of sepsis, caused by vasodilation and fluid loss from increased capillary permeability. The video notes that hypotension reduces oxygen delivery to tissues, which can result in organ dysfunction. Persistent hypotension is also a hallmark of septic shock.

💡Tachycardia

Tachycardia refers to an abnormally fast heart rate, often seen in sepsis as the body tries to compensate for low blood pressure and poor oxygen delivery. In the video, tachycardia is highlighted as a clinical manifestation of sepsis, signaling the body’s response to widespread infection and inflammation.

💡Multiple Organ Dysfunction Syndrome (MODS)

MODS is the final, life-threatening stage of sepsis, where two or more organs begin to fail due to the severe inflammatory response and poor blood flow. The video describes MODS as the endpoint in the sepsis continuum, with examples of organ failures such as respiratory and kidney impairment.

💡Hyperperfusion

Hyperperfusion occurs when blood flow to organs and tissues is insufficient, leading to tissue damage. In the video, hyperperfusion is mentioned in the context of sepsis-related organ damage, where elevated lactate levels indicate poor oxygen delivery to tissues.

💡Lactic Acidosis

Lactic acidosis is a condition characterized by the buildup of lactic acid in the body, often seen in severe sepsis due to anaerobic metabolism caused by poor oxygenation. The video discusses how lactic acidosis is a marker of organ dysfunction and metabolic failure, contributing to the progression of sepsis.

💡Septic Shock

Septic shock is a severe stage of sepsis characterized by persistent hypotension despite fluid resuscitation. The video explains that this condition is marked by a lack of response to treatment and leads to significant organ failure, making it a critical phase in the continuum of sepsis that often results in death if untreated.

Highlights

Sepsis is a continuum of systemic or widespread infection in the bloodstream that can lead to multiple organ failure.

Sepsis begins with bacterial invasion, causing a dysregulated immune response with inflammatory mediators triggering vasodilation and increased capillary permeability.

Vasodilation and capillary permeability result in hypotension (low blood pressure) and activate the coagulation and complement cascades.

The immune response can cause clotting in blood vessels, leading to blocked blood flow, poor tissue perfusion, and tissue damage.

Risk factors for sepsis include wounds (pressure injuries, traumatic wounds, or chronic non-healing wounds) and infections (kidney or lung).

Other risk factors: ICU admission, immune system deficiencies (e.g., HIV, cancer), recent surgeries, indwelling medical devices, and extremes of age.

Sepsis begins with general non-specific symptoms such as malaise and fever, followed by hypotension and tachycardia as the condition progresses.

Inflammatory response and tissue damage cause tachypnea, hypoxemia, low urine output, and edema.

Laboratory findings: increased white blood cell count with immature cells, elevated inflammatory markers (CRP, ESR), and hyperperfusion markers like serum lactate.

Sepsis continuum: begins with infection, progresses through systemic inflammatory response syndrome (SIRS), severe sepsis, septic shock, and potentially ends in multiple organ dysfunction syndrome (MODS).

SIRS is diagnosed with two or more criteria such as abnormal temperature, heart rate, respiratory rate, or white blood cell count.

Severe sepsis is identified by hypotension or hypoperfusion, leading to lactic acidosis and anaerobic metabolism, indicated by elevated lactate and low pH.

Septic shock is diagnosed when hypotension persists despite fluid resuscitation.

Multiple organ dysfunction syndrome (MODS) is the failure of two or more organs, which can include respiratory, liver, kidney, neurological, or cardiac impairments.

Untreated sepsis can lead to death due to widespread organ failure.

Transcripts

what is sepsis

sepsis is a continuum of systemic or

widespread infection in the bloodstream

that begins with bacterial invasion and

can lead to multiple organ failure

in sepsis a breach of the host barrier

often in the skin or mucous membranes

kicks off a dysregulated immune response

in the host

inflammatory mediators cause

vasodilation and increased capillary

permeability

these effects result in hypotension or

low blood pressure

they activate the coagulation cascade

and the complement cascade

the immune response involves the release

of pro-inflammatory mediators that cause

detrimental physiological effects such

as clotting in the blood vessels causing

blockage of blood flow and poor tissue

perfusion and tissue damage

risk factors for sepsis include an

existing wound such as a pressure

associated injury a traumatic wound or a

chronic non-healing wound

or infection such as a kidney or lung

infection

other risk factors include a hospital or

icu admission which puts a patient more

at risk for hospital-acquired infection

immune system deficiencies such as hiv

or cancer recent surgeries

indwelling medical devices like central

lines or urinary catheters very young or

very old age chronic disease or genetics

[Music]

general clinical manifestations for

sepsis

sepsis will begin with general

non-specific symptoms such as malaise

and fever

however as the inflammatory response and

tissue damage progresses we will observe

hypotension and tachycardia from the

vasodilation and capillary permeability

edema from the capillary permeability

tachypnea and hypoxemia due to tissue

damage and poor tissue perfusion

and low urine output due to poor

perfusion and kidney damage

laboratory results will show an

increased white blood cell count with a

greater number of young immature white

blood cells also known as a left shift

increased inflammatory markers such as

c-reactive protein and erythrocyte

sedimentation rate

markers of hyperperfusion such as

increased serum lactate and markers of

organ damage such as increased glucose

increased creatinine and increased

bilirubin

generally we will see positive blood

cultures as well

there will be signs of impaired

coagulation such as increased bleeding

times inr ptt and high or low platelet

count depending on the timing

sepsis occurs on a continuum

starting with infection and ending with

multiple organ dysfunction syndrome or

mods and then potentially death

initially a localized infection occurs

with localized inflammation

if not treated this can cause a

widespread inflammatory reaction called

systemic inflammatory response syndrome

also known as sirs

a sur's diagnosis is made of two or more

of the following occur

a temperature of greater than 38 or less

than 36 degrees celsius a heart rate

greater than 90 beats per minute a

respiratory rate over 20 a paco2 of less

than 32

a white blood cell count over 12 000 or

less than four thousand or greater than

ten percent bands

sepsis is diagnosed if there is a

diagnosed source of infection and the

patient meets ser's criteria

sirs may occur without an infection as

inflammation can occur for a number of

reasons

severe sepsis is accompanied by evidence

of hypotension or hypoperfusion

indicating lactic acidosis an sbp of

less than 90 or sbp drops greater than

or equal to 40 millimeters of mercury of

normal hypotension results in a decrease

of oxygen to the tissues causing

anaerobic metabolism and lactate

production

in this stage expect elevated lactate

low ph low bicarbonate and low blood

pressure

in septic shock hypotension remains

despite adequate fluid resuscitation

for example if a patient diagnosed with

severe sepsis received the fluid bolus

and had no improvement in their blood

pressure they would be considered to be

in septic shock

finally multiple organ dysfunction

syndrome mods is diagnosed when septic

shock is accompanied by evidence of two

or more organs failing

for example we may see respiratory

failure as impaired oxygenation and

ventilation that requires mechanical

ventilation

liver impairment that causes jaundice or

elevated liver enzymes kidney impairment

neurological impairment evidenced by

decreased mental status and cardiac

impairment as cardiac arrest

if left untreated mods can result in

death