A Clinical response arising from a nonspecific insult with 2 of the following Temp > 100.9 or > 96.8F HR>90 RR > 20 or pCO2 < 32 WBC > 12K, <4K,> 10% Bands SIRS with a presumed or confirmed infectious process Sepsis induced tissue hypoperfusion or organ dysfunction Respiratory Renal, GI CNS Hematologic Refractory hypotensionABLE 1. Diagnostic Criteria for Sepsis eiteret lM tere ue Mele eles MUR elem Rll elite General variables Fever (> 383°C) Hypothermia (core temperature < 36°C) Heart rate > 90/min-' or more than two so above the normal value for age Tachypnea Altered mental status Significant edema or positive fluid balance (> 20 mL/kg over 24 hr) Hyperglycemia (plasma glucose > 140 mg/dL or 7.7 mmol/L) in the absence of diabe Inflammatory variables Leukocytosis (WBC count > 12,000 pl-") Leukopenia (WBC count < 4000 pL!) Normal WBC count with greater than 109% immature forms Plasma C-reactive protein more than two so above the normal value Plasma orocalcitanin more than two sm above the normal valueHemodynamic variables ‘Arterial hypotension (SBP< 90mm Hg, MAP < 70mm Hg, or an SBP decrease > 40mm Hg in adults or less than two so below normal for age) Organ dysfunction variables Arterial hypoxemia (Pao,/Fio, < 300) ‘Acute oliguria (urine output < 0.5 mL /kg/hr for at least 2 hrs despite adequate fluid resuscitation) Creatinine increase > 0.5mg/dL or 44.2 pmol/L Coagulation abnormalities (INR > 15 or PTT > 60 s) lleus (absent bowel sounds) ‘Thrombocytopenia (platelet count < 100,000 pl) Hyperbilirubinemia (plasma total bliubin > 4 mg/dL or 70 pmol/L) Tissue perfusion variables Hyperlactatemia (> 1 mmol/L) Decreased capillary refill or mottling NEC = wiite blood col; SBP = systolic blood pressura; MAP'= mean arterial prossur; INR = intamstional nommalzed raio; aPTT = acvatad partial thromboplas jaca fr cps pcs ppt oe see nt spins armen wh apatite tpt > 38.5° or < 35°C), tachycardia (may be absent in hypothermic patients), and at least ane of the following indications of altered organ function: altered mental tus, hypoxemia, increased sorum lactate love, or bouncing pulses. Sdaptod from Levy MM, Fink MP, Marshall JC, et al: 2001 SCCM/ESICM/ACCPIATSISIS international Sepsis Definitions Conference. Crit Care Med 2003; 31 \250-1256.ABLE 2. Severe Sepsis EES ick) psis-i ST eD mee EU | eure following thought to be due to th ‘Sepsis-induced hypotension Lactate above upper limits laboratory normal Urine output < 0.5 mL/kg/hr for more than 2 hrs despite adequate fluid resuscitation ‘Acute lung injury with Pao,/Fio, < 250 in the absence of pneumonia as infection source ‘Acute lung injury with Pao,/Fro, < 200 in the presence of pneumonia as infection source Creatinine > 2.0mg/dL (176.8 pmol/L) Bilirubin > 2mg/dL (24.2 wmol/L) Platelet count < 100,000 pL Coagulopathy (international normalized ratio > 15) dapted from Levy MM, Fink MP, Marshall JC, et al: 2001 SCCM/ESICM/ACCPIATS/SIS Intemational Sepsis Definitions Conference. Crit Care Mad 2003; 250-1 258.