Early Recognition and Diagnosis of Septic Shock

Early Recognition and Diagnosis of Septic Shock

• Other physiological signs of poor organ perfusion can serve as historical indicators of low blood flow or predictors of discharge with an arrhythmic event.
• Acute kidney injury, characterized by a creatinine level >2 mg/dL, is a key indicator of poor organ perfusion.
• Progression to septic shock is associated with an in-hospital mortality ranging from 12.5% to 49.7%.
• It is essential to differentiate between community-acquired septic shock, healthcare-acquired septic shock, and hospital-acquired septic shock, as the causative bacteria may differ.
• Identifying the bacteria causing the septic shock informs the choice of empirical broad-spectrum antibiotic therapy.
• Recent treatment with antibiotics, such as amoxicillin or macrolides, may have eradicated vaginal bacterial anaerobes, leading to gut dysbiosis and bacteremias.

Diagnostic Criteria for Septic Shock

• Septic shock diagnosis requires recognition of systemic infection and clinical signs of substantial tissue perfusion abnormalities.
• The American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) diagnostic criteria for septic shock, known as 'Sepsis-2', include:
  • Acute organ dysfunction
  • Hypotension (systolic arterial pressure <90 mmHg or a decrease of ≥40 mmHg from baseline)
  • Additional clinical or laboratory evidence of acute organ dysfunction