Sepsis definitions

Abstract

We found Jean-Louis Vincent and colleagues' Viewpoint (March 2, p 774)1Vincent J-L Opal SM Marshall JC Tracey KJ Sepsis definitions: time for change.Lancet. 2013; 381: 774-775Summary Full Text Full Text PDF PubMed Scopus (468) Google Scholar very interesting. Although we agree with most of the contents of their Viewpoint, we think that the definition of sepsis—systemic inflammatory response syndrome (SIRS) caused by (probable or documented) infection2American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis.Crit Care Med. 1992; 20: 864-874Crossref PubMed Scopus (4842) Google Scholar—given by the North American consensus should be maintained.The four clinical criteria defining SIRS (temperature, heart rate, respiratory rate, and white blood cell count) are easily measurable, and should be altogether considered not only by emergency rooms, intensive care, and infectious disease specialists, but by all physicians. In fact, infections can complicate any disease, and can occur in any patient. In many parts of the world (even in developed countries), SIRS criteria are not routinely interpreted to suspect sepsis. Furthermore, by contrast with pulse rate determination—a procedure historically associated with medical examination—the determination of respiratory rate is not part of the clinical practice of many physicians.3Butler-Williams C Cantrill N Maton S Increasing staff awareness of respiratory rate significance.Nurs Times. 2005; 101: 35-37PubMed Google Scholar, 4Watson D The impact of accurate patient assessment on quality of care.Nurs Times. 2006; 102: 34-37PubMed Google Scholar, 5Cretikos MA Bellomo R Hillman K Chen J Finfer S Flabouris A Respiratory rate: the neglected vital sign.Med J Aust. 2008; 188: 657-659PubMed Google Scholar Surely, the definition of sepsis has little specificity. But importantly, it allows identification of patients who need medical re-evaluation. If organ dysfunction were included as a necessary criterion for defining sepsis, many patients would not receive the attention they deserve, thus compromising early diagnosis. The importance of the current definition is not for the intensivists, it is for all other physicians.We declare that we have no conflicts of interest. We found Jean-Louis Vincent and colleagues' Viewpoint (March 2, p 774)1Vincent J-L Opal SM Marshall JC Tracey KJ Sepsis definitions: time for change.Lancet. 2013; 381: 774-775Summary Full Text Full Text PDF PubMed Scopus (468) Google Scholar very interesting. Although we agree with most of the contents of their Viewpoint, we think that the definition of sepsis—systemic inflammatory response syndrome (SIRS) caused by (probable or documented) infection2American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis.Crit Care Med. 1992; 20: 864-874Crossref PubMed Scopus (4842) Google Scholar—given by the North American consensus should be maintained. The four clinical criteria defining SIRS (temperature, heart rate, respiratory rate, and white blood cell count) are easily measurable, and should be altogether considered not only by emergency rooms, intensive care, and infectious disease specialists, but by all physicians. In fact, infections can complicate any disease, and can occur in any patient. In many parts of the world (even in developed countries), SIRS criteria are not routinely interpreted to suspect sepsis. Furthermore, by contrast with pulse rate determination—a procedure historically associated with medical examination—the determination of respiratory rate is not part of the clinical practice of many physicians.3Butler-Williams C Cantrill N Maton S Increasing staff awareness of respiratory rate significance.Nurs Times. 2005; 101: 35-37PubMed Google Scholar, 4Watson D The impact of accurate patient assessment on quality of care.Nurs Times. 2006; 102: 34-37PubMed Google Scholar, 5Cretikos MA Bellomo R Hillman K Chen J Finfer S Flabouris A Respiratory rate: the neglected vital sign.Med J Aust. 2008; 188: 657-659PubMed Google Scholar Surely, the definition of sepsis has little specificity. But importantly, it allows identification of patients who need medical re-evaluation. If organ dysfunction were included as a necessary criterion for defining sepsis, many patients would not receive the attention they deserve, thus compromising early diagnosis. The importance of the current definition is not for the intensivists, it is for all other physicians. We declare that we have no conflicts of interest. Sepsis definitions: time for changeFor the Ancient Greeks, sepsis referred to rot, decay, or putrefaction. Galen and Celsus described the signs of inflammation as peripheral vasodilatation (rubor), fever (calor), pain (dolor), increased capillary permeability (tumor), and organ dysfunction (functio laesa). Full-Text PDF Sepsis definitions – Authors'replyAntonio Cascio and Chiara Iaria express concern that removing the systemic inflammatory response syndrome (SIRS) criteria might delay the evaluation and treatment of patients who are infected. We certainly do not intend to diminish the urgent need for rapid assessment of any sick patient with abnormal vital signs and leucocytosis. We agree that early identification and treatment of infection is the priority in managing septic patients, but the SIRS criteria are neither sensitive nor specific for infection. Full-Text PDF