Organ dysfunction
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7198.1606 (Published 12 June 1999) Cite this as: BMJ 1999;318:1606- Timothy W Evans,
- Mark Smithies
Most illness and death in patients in intensive care is caused by the consequences of sepsis and systemic inflammation. These conditions are responsible for an estimated 100 000 deaths a year in the United States alone. The systemic inflammatory response syndrome (SIRS) produces a clinical reaction that is indistinguishable from sepsis in the absence of an infecting organism
Understanding the pathogenesis of multiple organ failure is the key to reducing the unacceptably high mortality associated with sepsis
Definitions of systemic inflammatory response syndrome (SIRS), sepsis, septic shock, and multiple organ dysfunction syndrome (American College of Chest Physicians, 1992)
Systemic inflammatory response syndrome
Two or more of the following clinical signs of systemic response to endothelial inflammation:
Temperature >38°C or <36°C
Heart rate >90 beats/min
Tachypnoea (respiratory rate >20 breaths/min or hyperventilation (PaCO2<4.25 kPa))
White blood cell count >12×109/l or <4×109/l or the presence of more than 10% immature neutrophils
In the setting (or strong suspicion) of a known cause of endothelial inflammation such as:
Infection (bacteria, viruses, fungi, parasites, yeasts, or other organisms)
Pancreatitis
Ischaemia
Multiple trauma and tissue injury
Haemorrhagic shock
Immune mediated organ injury
Absence of any other known cause for such clinical abnormalities
Sepsis
Systemic response to infection manifested by two or more of the following:
Temperature >38°C or <36°C
Raised heart rate >90/min
Tachypnoea (respiratory rate >20 breaths/min or hyperventilation (PaCO2<4.25 kPa))
White blood cell count >12×109/l or <4×109/l or the presence of more than 10% immature neutrophils
Septic shock
Sepsis induced hypotension (systolic blood pressure <90 mm Hg or a reduction of 40 mm Hg from baseline) despite adequate fluid resuscitation
Multiple organ dysfunction syndrome
Presence of altered organ function in an acutely ill patient such that homoeostasis cannot be maintained without intervention
Pathogenesis
Systemic sepsis may complicate an obvious primary infection such as community acquired pneumonia or a ruptured abdominal viscus. Frequently, however, an infective source cannot be identified and the type of organism cultured …
Log in
Log in using your username and password
Log in through your institution
Subscribe from £173 *
Subscribe and get access to all BMJ articles, and much more.
* For online subscription
Access this article for 1 day for:
£38 / $45 / €42 (excludes VAT)
You can download a PDF version for your personal record.