The

Updated Sepsis Deni0ons

Dr. Rudy Manalu, SpAn.KIC.

Sepsis -1 from 1991

Chest. 1992 Jun;101(6):1644-55.
Deni&ons for sepsis and organ failure and guidelines for the use of
innova&ve therapies in sepsis. The ACCP/SCCM Consensus Conference
Commi?ee. American College of Chest Physicians/Society of Cri&cal
Care Medicine.
Bone RC1, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA,
Schein RM, Sibbald WJ.

Abstract
An American College of Chest Physicians/Society of Cri0cal Care Medicine Consensus
Conference was held in Northbrook in August 1991 with the goal of agreeing on a set of
deni0ons that could be applied to pa0ents with sepsis and its sequelae. New deni0ons were
oered for some terms, while others were discarded. Broad deni0ons of sepsis and the
systemic inammatory response syndrome were proposed, along with detailed physiologic
parameters by which a pa0ent may be categorized. Deni0ons for severe sepsis, sep0c shock,
hypotension, and mul0ple organ dysfunc0on syndrome were also oered. The use of severity
scoring methods when dealing with sep0c pa0ents was recommended as an adjunc0ve tool to
assess mortality. Appropriate methods and applica0ons for the use and tes0ng of new therapies
were recommended. The use of these terms and techniques should assist clinicians and
researchers who deal with sepsis and its sequelae.

Sepsis-2 from 2001

Crit Care Med. 2003 Apr;31(4):1250-6.

2001 SCCM/ESICM/ACCP/ATS/SIS Interna&onal Sepsis
Deni&ons
Conference.
Levy MM1, Fink MP, Marshall JC, Abraham E, Angus D, Cook D,
Cohen J,
Opal SM, Vincent JL, Ramsay G; SCCM/ESICM/ACCP/ATS/SIS.

Abstract
OBJECTIVE:
In 1991, the American College of Chest Physicians (ACCP) and the Society of Cri0cal Care
Medicine (SCCM) convened a "Consensus Conference," the goals of which were "to provide a
conceptual and a prac0cal framework to dene the systemic inammatory response to
infec0on, which is a progressive injurious process that falls under the generalized term 'sepsis'
and includes sepsis-associated organ dysfunc0on as well." The general deni0ons introduced as
a result of that conference have been widely used in prac0ce and have served as the founda0on
for inclusion criteria for numerous clinical trials of therapeu0c interven0ons. Nevertheless,
there has been an impetus from experts in the eld to modify these deni0ons to reect our
current understanding of the pathophysiology of these syndromes.

The New Sepsis-3

Deni0on was created by the ESICM-SCCM
Sepsis Redeni0ons Task Force

SCCM (The Society of Cri0cal Care Medicine)

ESICM (The European Society of Intensive Care Medicine)

THE THIRD INTERNATIONAL CONSENSUS

DEFINITIONS FOR SEPSIS AND SEPTIC SHOCK
(SEPSIS-3)
Sepsis : life-threatening organ dysfunc0on caused by
dysregulated host response to infec0on
SIRS is no longer used due to low specicity
SOFA or qSOFA used
Organ dysfunc0on can be iden0ed as an acute change in
total SOFA score 2 points consequent to the infec0on
qSOFA can be used in the non-ITU sejng requiring 2 of the
following in suspected infec0on : Blood Pressure ( 100
mmHg syst) , Altered Mental Status , Tachypnoea (RR22/
min) (BAT)
Sep0c shock can be iden0ed in these pa0ents and with
persis0ng hypotension requiring vasopressors to maintain
MAP 65 mmHg and having a serum lactate level > 2 mmol/
L despite adequate volume resuscita0on

OLD
SEPSIS

NEW

SIRS

SUSPECTED/DOCUMENTED INFECTION

+
+ 2 or 3 on qSOFA (BAT)

Blood Pressure ( 100 mmHg syst) ,
Suspected infec0on
Altered Mental Status , Tachypnoea (RR

22 /min) +

Rise in SOFA Score by 2 or more

SEVERE
SEPSIS
SEPSIS +
SBP < 90 mmHg or MAP < 65 mmHg

Lactate > 2.0 mmol/L

INR >1.5 or PTT > 60 s

Bilirubin > 34 mol/L

Urine out put < 0.5 mL/kg/h for 2 hour

Crea0nine >177 mol/L

Platelets < 100 x 109/L

SpO2 < 90 % on room air
SEPTIC
SEPSIS
SHOCK +

HYPOTENSION

aver adequate uid resuscita0on

Category removed

SEPSIS +
VASOPRESSORS needed for MAP > 65
+
Lactate > 2 mmol/L
aver adequate uid resuscita0on

SOFA Score

qSOFA

Es0ma0ng PaO2 from given SO2

SO2 (%)

PaO2 ( mmHg)

SO2 (%)

PaO2 ( mmHg)

80

44

91

62

81

45

92

65

82

46

93

69

83

47

94

73

84

49

95

79

85

50

96

86

86

52

97

96

87

53

98

112

88

55

99

145

89

57

90

60

Method
Nasal Cannulla

Nasopharyngeal Catheter

Simple Face Mask

Face Mask with reservoir

Es0ma0ng FiO2
O2 Flow (L/mnt)

Es&mated FiO2

0.24

0.28

0.32

0.36

0.4

0.4

0.5

0.6

0.4

6-7

0.5

0.6

0.6

0.7

0.8

0.9

10

0.95

quick
Sepsis-related
Organ
Failure
Assesment
H

Opera&onaliza&on of Clinical Iden&fying Pa&ents with Sepsis and Sep&c Shock

Suspected Infec0on
Were Here !

No

qSOFA 2
Yes

Ward, ER
Sepsis s0ll
Suspected
?

Yes

Assess for evidence of

Organ dysfunc0on

No
SOFA 2

No

Monitor Clinical condi0on

Reevaluate for possible Sepsis
if indicated

Yes
SEPSIS

No

SEPTIC SHOCK
Despite uid administra0on
1.Vasopressor required for
MAP 65 and
2. Lactate > 2 mmol/L

Yes

SEPSIS

SEPTIC SHOCK

DEFINITION

Sepsis is life-threatening organ
dysfunc0on due to dysregulated
host responses to infec0on

Clinical
Criteria

SUSPECTED/DOCUMENTED INFECTION
+
SEPSIS
2 or 3 on qSOFA (BAT)
+
Blood Pressure ( 100 mmHg syst) ,
VASOPRESSORS needed for MAP > 65
Altered Mental Status , Tachypnoea (RR
+
22/min)
Lactate > 2 mmol/L
+
aver adequate uid resuscita0on

Rise in SOFA Score by 2 or more

Recommended
primary ICD
Codes
ICD-9
ICD-10a

Sep&c shock is a subset of sepsis where
underlying circulatory and cellular/
metabolic abnormali0es are profound
enough to substan0ally increase
mortality

995.92
R65.20

785.52
R65.21