HelixTalk Episode #58 - Third time’s a charm -- redefining sepsis (again) using Sepsis-3

Date posted: March 21, 2017, 6:00 am

In this episode, we discuss the newest definition of sepsis and septic shock according to the Sepsis-3 criteria and the 2016 Surviving Sepsis guidelines.  We also review the scoring systems of “qSOFA” and “SOFA” and use a patient case to help demonstrate the new definitions.

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Key Concepts

1. The definitions regarding to sepsis have changed three times since 1991.  The current definition (called Sepsis-3) describes “sepsis” and “septic shock”.
2. “qSOFA” is a quick screening tool to quickly identify patients who MAY have sepsis.  If a patient has 2 or 3 qSOFA criteria, a confirmatory “SOFA” score is required to meet the definition of sepsis.
3. “SOFA” is a scoring tool that requires several lab values and vital signs that is now used to objectively define sepsis.  Patients are defined as having sepsis if they have a suspected infection and an acute change of the SOFA score of 2 or more points from baseline.
4. Septic shock is defined as meeting the sepsis definition (suspected infection plus a SOFA change of 2 or more from baseline) AND have hypotension requiring vasopressors to maintain a MAP >= 65 mmHg AND have an elevated lactate level (>2 mmol/L) despite having adequate fluid resuscitation.

References

1. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10. doi: 10.1001/jama.2016.0287.
2. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017 Mar;45(3):486-552. doi: 10.1097/CCM.0000000000002255.
3. qSOFA (quick Sepsis Related Organ Failure Assessment) website: http://www.qsofa.org/