SNDROME DE

RESPUESTA
INFLAMATORIA
SISTEMICA

MR1-MED

Yul Jimmy Cruz Cusihualpa

DEFINICION

Body temperature less than 36C or greater

than 38C
Heart rate greater than 90 beats per minute
Tachypnea (high respiratory rate), with
greater than 20 breaths per minute; or, an
arterial partial pressure of carbon dioxide less
than 4.3 kPa (32 mmHg)
White blood cell count less than 4000
cells/mm (4 x 109 cells/L) or greater than
12,000 cells/mm (12 x 109 cells/L); or the
presence of greater than 10% immature
neutrophils (band forms).
GUIDELINE, Bone RC. Definitions for sepsis and organ failure and guidelines for the use of
innovative therapies in sepsis. The ACCP/SCCAM Consensus Conference Commmittee. 1992

Preambulo

Infeccin.

Bacteremia.

Sepsis.

Shock septico.

Rangel-Fausto MS. The natural history of the systemic inflammatory

response syndrome (SIRS).A prospective study.JAMA 2005

Causas
BACTERIAS

PANCREATITIS
HONGOS

INFECCIN SEPSI

SIRS

TRAUMA

PARSITOS

QUEMAD
QUEMADOS
VIRUS
OTROS

OTROS

Heffner AC. Horton JM. Etiology of illness in patients with severe sepsis admitted to
the hospital from the emergenncy department. Clinc infect. March 2010

Epidemiologia
Rangel-Fausto
UCI 68%.
26% sepsis.
4-8% choque septico.

Angus DC. Linde-Zwirble WT. Epidemiology of severe sepsis in the United States: Analysis of
incidence, outcome, and associated costs of care. Crit care Med . 2001
Rangel-Fausto MS. The natural history of the systemic inflammatory response syndrome
(SIRS).A prospective study.JAMA 2005

Fisiopatologia
LESIN
RESPUESTA LOCAL
Citocinas

Macrofgos

Fase I
Cls. endoteliales

RESPUESTA PARACRINA / AUTOCRINA

Fase II
ALTERACIN EN LA HOMEOSTASIS
Fase III

SIRS

Presentacion
clinica

Historia

Comstedt P. The systemic Inflammatory response Syndrome in acutely hospitalised medical

patients.Emerd Med . Dec 2010

Comstedt P. The systemic Inflammatory response Syndrome in

acutely hospitalised medical patients.Emerd Med . Dec 2010

Presentacion

Examen fisico.

Revision cuidadosa de los signos.

Comstedt P. The systemic Inflammatory response Syndrome in acutely hospitalised medical

patients.Emerd Med . Dec 2010

Presentacion

Comstedt P. The systemic Inflammatory response Syndrome in

acutely hospitalised medical patients.Emerd Med . Dec 2010

Complicaciones

Falla respiratoria, sndrome de insuficiencia

respiratoria aguda (ARDS), y neumona
nosocomial.
Fallo renal.
Sangrado gastrointestinal y gastritis de stress.
Anemia.
TVP.
Desequilibrio hidroelectrolitico.
Coagulacin intravascular diseminada.

Rangel-Fausto MS. The natural history of the systemic inflammatory

response syndrome (SIRS).A prospective study.JAMA 2005

Educacion

Pronostico
Las tazas de mortalidad mencionadas
por Rangel-Faus study fueron de 7%
(SIRS), 16% (sepsis), y 46% (choque
septico).
Los pacientes hospitalizados con SIRS
presentan una taza de mortalidad de 6.8
mayor a los que no padecen.

Angus DC. Linde-Zwirble WT. Epidemiology of severe sepsis in the United States: Analysis of
incidence, outcome, and associated costs of care. Crit care Med . 2001
Rangel-Fausto MS. The natural history of the systemic inflammatory response syndrome
(SIRS).A prospective study.JAMA 2005