What should be considered in the early diagnosis of sepsis/septic shock?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

The diagnosis of septic shock requires features of SIRS (eg, mental changes, hyperventilation, distributive hemodynamics, hyperthermia or hypothermia, or reduced, elevated, or left-shifted white blood cells [WBCs]) in addition to a potential source of infection.

Whenever a patient presents with shock, an early working diagnosis must be formulated, an approach to urgent resuscitation must be established, and steps must be taken to confirm the working diagnosis. The following points should be considered for early diagnosis of sepsis:

  • Patients with sepsis may present in a myriad of ways, and high clinical suspicion is necessary to identify subtle presentations [56]

  • Patients in a septic state should be screened for evidence of tissue hypoperfusion, such as cool or clammy skin, mottling, and elevated shock index (heart rate−to−systolic blood pressure >0.9)

  • A lactic acid level higher than 4 mmol/dL has been used as an entry criterion for early goal-directed therapy (EGDT) and an indicator of severe tissue hypoperfusion


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