Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- temperatura alta (>38 °C) ou baixa (<36 °C)
- taquicardia
- taquipneia
- estado mental alterado agudamente
- enchimento capilar lentificado, pele com manchas vermelhas e roxas variadas ou com aspecto acinzentado
- sinais associados à causa específica de infecção
- baixa saturação de oxigênio
- hipotensão arterial
- débito urinário diminuído
- cianose
Other diagnostic factors
- púrpura fulminante
- icterícia
- íleo paralítico
Risk factors
- idade >65 anos
- imunocomprometimento
- sondas intravenosas ou vesicais de demora
- cirurgia recente ou outros procedimentos invasivos
- hemodiálise
- diabetes mellitus
- uso de substâncias por via intravenosa
- transtornos decorrentes do uso de bebidas alcoólicas
- integridade cutânea prejudicada
- gestação
- residência em área urbana
- doença pulmonar
- sexo masculino
- ascendência não branca
- estação do inverno
Diagnostic investigations
1st investigations to order
- hemocultura
- níveis de lactato
- Hemograma completo com diferencial
- ureia sanguínea e eletrólitos séricos
- creatinina sérica
- testes da função hepática
- estudos de coagulação (razão normalizada internacional [INR], tempo de tromboplastina parcial [TTP] ativada)
- glicose sérica
- proteína C-reativa
- outras culturas (por exemplo, de escarro, fezes, urina, feridas, cateteres, implantes protéticos, locais epidurais, líquido pleural ou peritoneal)
- gasometria arterial ou venosa
- radiografia torácica
- eletrocardiograma (ECG)
Investigations to consider
- punção lombar
- ecocardiografia (transtorácica ou transesofágica)
- ultrassonografia
- TC de tórax ou abdome
- procalcitonina sérica
Treatment algorithm
sepse presumida ou confirmada
Contributors
Authors
Andre C. Kalil, MD, MPH, FACP, FIDSA, FCCM
Professor
Department of Internal Medicine
Division of Infectious Diseases
University of Nebraska Medical Center
Omaha
NE
Disclosures
ACK declares that he has no competing interests.
Kelly Cawcutt, MD, MS, FACP, FIDSA, FCCM
Associate Professor
Department of Internal Medicine
Division of Pulmonary, Critical Care, Sleep & Allergy
University of Nebraska Medical Center
Omaha
NE
Disclosures
KC has received payment for medical writing from IDSA and CloroxPro. KC has received honoraria for creation of educational materials from the Society for Healthcare Epidemiology of America (SHEA) and payment from BD. KC has received honoraria and travel expenses from NAPA. KC has received payment for book proposal review from Elsevier. KC has participated as author, lecturer, and committee member for the Society of Critical Care Medicine (SCCM) course and book, providing content on controversies in sepsis.
Acknowledgements
Professor Andre Kalil and Dr Kelly Cawcutt would like to gratefully acknowledge Dr Ron Daniels, Dr Matt Inada-Kim, Dr Aamir Saifuddin, Dr Tim Nutbeam, Dr Edward Berry, Dr Lewys Richmond, and Dr Paul Kempen, previous contributors to this topic.
Disclosures
RD has received payment for consultancy on sepsis from Kimal Plc, manufacturers of vascular access devices; from the Northumbria Partnership, a patient safety collaborative; and, where annual leave or other income was compromised in fulfilling his charity duties, from the UK Sepsis Trust. RD has received sponsorship to attend and speak at one meeting from Abbott Diagnostics. He is CEO of the UK Sepsis Trust and Global Sepsis Alliance, and advises HM Government, the World Health Organization, and NHS England on sepsis. Each of these positions demands that he express opinion on strategies around the recognition and management of sepsis. MIK is a national clinical advisor on sepsis to NHS England and a national clinical advisor on deterioration to NHS Improvement. He was reimbursed for a slide set by Relias Learning. AS is the clinical fellow to the National Medical Director at NHS Improvement. AS has been sponsored on two occasions by Dr Falk Pharma UK to attend specialist gastroenterology conferences abroad; there was no contractual obligation to disseminate product information. TN is a clinical adviser to the UK Sepsis Trust. EB, LR, and PK declare that they have no competing interests.
Peer reviewers
Steven M. Opal, MD, FIDSA
Professor of Medicine
Infectious Disease Division
Rhode Island Hospital
Alpert Medical School of Brown University
Providence
RI
Disclosures
SMO declares that he has no competing interests.
Laura Evans, MD, MSc, FCCP, FCCM
Associate Professor
NYU School of Medicine
Medical Director of Critical Care
Bellevue Hospital Center
New York
NY
Disclosures
LE serves as the guidelines co-chair and on the steering committee of the Surviving Sepsis Campaign.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10.Full text Abstract
National Institute for Health and Care Excellence. Sepsis: recognition, diagnosis and early management. Sep 2017 [internet publication].Full text
Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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