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KMID : 1040120160020030111
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Evidence and Values in Healthcare
2016 Volume.2 No. 3 p.111 ~ p.118
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The third international consensus definitions for sepsis and septic shock (Sepsis-3)
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Kim Jae-Yeol
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Abstract
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The Third International Consensus Definitions Task Force appointed by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine performed face-to-face meetings, Delphi processes, analysis of electronic health record databases, and voting, follow by circulation to international professional societies. The Task Force defined sepsis as “life-threatening organ dysfunction due to a dysregulated host response to infection.” A new bedside clinical score termed ‘quick Sequential [Sepsis-related] Organ Failure Assessment’ (qSOFA) which contains respiratory rate of 22/min or greater, altered mentation, or systolic blood pressure of 100 mmHg or less was chosen as a screening criteria for sepsis. For clinical operationalization, organ dysfunction was represented by an increase in the SOFA score of 2 points or more, which grades oxygenation, Glasgow Coma Scale, mean arterial pressure, vasopressor, serum creatinine, bilirubin and platelet count in a range of 0 to 24. The term “severe sepsis” was considered to be redundant and was discarded. Septic shock was defined as “a subset of sepsis in which underlying circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than sepsis alone.” Patients with septic shock can be clinically identified by a vasopressor requirement to maintain a mean arterial pressure of 65 mmHg greater and serum lactate level greater than 2 mmol/L in the absence of hypovolemia. Updated definitions and clinical criteria offer greater consistency for epidemiologic studies and clinical trials, and facilitate earlier recognition and more timely management
of patients with sepsis or septic shock.
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KEYWORD
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Sepsis, Septic shock, Definition, SOFA, Consensus
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