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Upon completion of the chapter, the reader will be able to:

  1. Compare and contrast the definitions of syndromes related to sepsis.

  2. Identify the pathogens associated with sepsis.

  3. Discuss the pathophysiology of sepsis as it relates to pro- and anti-inflammatory mediators.

  4. Identify patient symptoms as early or late sepsis and evaluate diagnostic and laboratory tests for patient treatment and monitoring.

  5. Assess complications of sepsis and discuss their impact on patient outcomes.

  6. Design desired treatment outcomes for septic patients.

  7. Formulate a treatment and monitoring plan (pharmacologic and nonpharmacologic) for septic patients.

  8. Evaluate patient response and devise alternative treatment regimens for nonresponding septic patients.




  • Image not available. Sepsis is a continuum of stages defined by physiologic measures and signs and symptoms of a sepsis process.

  • Image not available. Gram-positive and gram-negative bacteria, fungal species, and viruses may cause sepsis.

  • Image not available. Inflammation is the key factor in the development of sepsis. Patients with severe infections, trauma, debilitating conditions, or an immunocompromised status may experience an imbalance among inflammatory mediators that progresses to sepsis.

  • Image not available. The cumulative burden of sepsis complications is the leading factor of mortality. The risk of death increases 20% with failure of each additional organ. Severe sepsis averages two failed organs, with a mortality rate of 40%.

  • Image not available. Treatment is aimed at early goal-directed resuscitation; reducing or eliminating organ failures; treating and eliminating the source of infection; avoiding adverse reactions of treatment; and providing cost-effective therapy.

  • Image not available. Appropriate empiric anti-infective therapy administered within 1 hour of the recognition of sepsis decreases complications and 28-day mortality.


Sepsis is a continuum of physiologic stages characterized by infection, systemic inflammation, and hypoperfusion with widespread tissue injury.1 Image not available. The American College of Chest Physicians and the Society of Critical Care Medicine developed definitions to utilize for sepsis (Table 82–1).2 Physiologic parameters categorize patients as having bacteremia, infection, systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, or multiple-organ dysfunction syndrome (MODS).2 Standardized definitions have been developed for infections in critically ill patients.3

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Table 82–1Definitions Related to Sepsis

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