www.surgicalnotes.co.uk

SIRS (Systemic Inflammatory Response Syndrome)

Syndrome arising from body's reaction to critical illness

1. 36 > Temperature > 38


2. Tachycardia >90/min


3. Tachypnoea > 20


4. 4 > WCC > 12

Pathophysiology

1. Phase I: Local acute inflammatory response (neutrophils, macrophages) + release of inflammatory cytokines


2. Phase II: Systemic distribution of mediators (normally IL-10 ensures systemic response is limited)


3. Phase III: Cytokine Storm leads to recognised outcomes TTTWCC

Triggers

1. Trauma / burns


2. Sepsis 

Sepsis

1. SIRS + Infective focus (cf bacteraemia - presence of viable bacteria in circulation)

MODS - Multi Organ Dysfunction Syndrome

Presence of altered and potentially reversible organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention. 

1. Primary MODS
   
   
   
   • Directly due to initial insult


2. Secondary MODS
   
   
   
   
   • Occurs as result of SIRS
   
   
   • May be a latent period between initial event and subsequent organ failure

Organs affected

1. Cardiovascular


2. Lungs - ARDS, V/Q mismatch


3. Kidneys - ARF


4. Gut - ileus, bacterial translocation (mucosa sensitive to ischaemia, loses integrity and function)


5. Liver - deranged LFTs


6. Coagulation

Managment

Circulatory support
Ventilatory support
Renal support
Nutrition support
Antibiotics