Definitions / pathophysiology:
Sepsis: infection + ≥2 organ system dysfunction (eg, encephalopathy, ARDS, DIC)
Septic shock: sepsis + refractory hypotension (ie, vasopressors) + ↑ lactate (hypoperfusion)
Work-up / management:
First 1-3 hr: cultures, empiric antibiotics & crystalloid (eg, lactated Ringer) resuscitation
Evaluate: infection source, sequential organ dysfunction
Organ protection: keep MAP at least 65 mm Hg, low tidal volume ventilation, glucose control
Prognosis:
Mortality predictors: sequential organ failure (~15%/system), ↑↑ lactic acidosis (≥4 mmol/L)
Late mortality: mainly nosocomial infections (postseptic immune paralysis)
PICS: cognitive, emotional & physical impairments in most survivors
