Última revisão: 1 Set 2020
Última atualização: 15 Out 2018

Resumo

Definição

História e exame físico

Principais fatores de diagnóstico

  • 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

Outros fatores de diagnóstico

  • púrpura fulminante
  • icterícia
  • íleo paralítico

Fatores de risco

  • neoplasia subjacente
  • idade >65 anos
  • imunocomprometimento
  • hemodiálise
  • alcoolismo
  • diabetes mellitus
  • cirurgia recente ou outros procedimentos invasivos
  • integridade cutânea prejudicada
  • acessos venosos ou cateteres
  • uso indevido de substâncias por via intravenosa
  • gestação
  • residência em área urbana
  • doença pulmonar
  • sexo masculino
  • ascendência não branca
  • estação do inverno

Exames diagnósticos

1° exames a serem solicitados

  • Hemograma completo com diferencial
  • ureia sanguínea e eletrólitos séricos
  • creatinina sérica
  • teste da função hepática
  • estudos de coagulação (razão normalizada internacional [INR], tempo de tromboplastina parcial ativada [TTPa])
  • glicose sérica
  • níveis de lactato
  • proteína C-reativa
  • hemocultura
  • 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)
Mais 1° exames a serem solicitados

Exames a serem considerados

  • punção lombar
  • ecocardiografia (transtorácica ou transesofágica)
  • ultrassonografia
  • TC de tórax ou abdome
  • procalcitonina sérica
Mais exames a serem considerados

Algoritmo de tratamento

Colaboradores

Chief Executive

United Kingdom Sepsis Trust

Chief Executive

Global Sepsis Alliance

Programme Director

Survive Sepsis

Consultant in Critical Care and Anaesthesia

Heart of England NHS Foundation Trust

Birmingham

UK

Divulgações

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 Organisation and NHS England on sepsis. Each of these positions demands that he express opinion on strategies around the recognition and management of sepsis.

Consultant Acute Physician & Sepsis Lead

Department of Acute Medicine

Royal Hampshire County Hospital

Hampshire Hospitals NHS Foundation Trust

Winchester

UK

Divulgações

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.

Specialty Registrar in Gastroenterology and General Medicine

Maidstone and Tunbridge Wells NHS Trust

UK

Divulgações

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.

Consultant in Emergency Medicine

Clinical Academic

University of Plymouth

Lead Doctor

Devon Air Ambulance Trust

Derriford Hospital

Plymouth

UK

Divulgações

TN is a clinical adviser to the UK Sepsis Trust.

Specialty Registrar in Emergency Medicine

Derriford Hospital

Plymouth

UK

Divulgações

EC declares that he has no competing interests.

Dr Ron Daniels, Dr Matt Inada-Kimand, Dr Aamir Saifuddin, Dr Tim Nutbeam, and Dr Edward Berry would like to gratefully acknowledge Dr Lewys Richmond and Dr Paul Kempen, previous contributors to this topic. LR and PK declare that they have no competing interests.

Colegas revisoresMOSTRAR TODOS

Professor of Medicine

Infectious Disease Division

Rhode Island Hospital

Alpert Medical School of Brown University

Providence

RI

Divulgações

SMO declares that he has no competing interests.

Associate Professor

NYU School of Medicine

Medical Director of Critical Care

Bellevue Hospital Center

New York

NY

Divulgações

LE serves as the guidelines co-chair and on the steering committee of the Surviving Sepsis Campaign.

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