AMERICAN-COLLEGE-OF-CHEST-PHYSICIANS SOCIETY-OF-CRITICAL-CARE-MEDICINE CONSENSUS CONFERENCE DEFINITIONS OF THE SYSTEMIC INFLAMMATORY RESPONSE SYNDROME AND ALLIED DISORDERS IN RELATION TO CRITICALLY INJURED PATIENTS

Objectives: To determine the frequency of the proposed definitions for the systemic inflammatory response syndrome (SIRS), sepsis and septic shock, and to further define severe SIPS and sterile shock as determi ned at 24 hrs of admission to an intensive care unit (ICU) in critical ly ill trauma patients without head injury, and their relationships to mechanism of injury, Acute Physiology and Chronic Health Evaluation ( APACHE) II score, risk of death, Injury Severity Score (ISS), number o f organ failures, and mortality rate. Design: Prospective, inception c ohort analysis. Setting: Sixteen-bed surgical ICU in a teaching hospit al. Patients: Four hundred fifty critically injured patients without a ssociated head trauma. Penetrating trauma accounted for 70% (gunshot 2 02; stab 113) and nonpenetrating trauma for 30% (motor vehicle collisi on 103; blunt 32) of admissions. Three hundred ninety-four (88%) patie nts underwent surgical procedures. Interventions: None. Measurements a nd main results: Infective and noninfective insults were distinguished by the need for therapeutic or prophylactic antibiotics, respectively , based on an established antibiotic policy. Three hundred ninety-five (87.8%) patients fulfilled a definition of the SIPS criteria. The fre quency of the definitive categories was SIPS 21.8%, sepsis 14.4%, seve re SIPS 8.4%, severe sepsis 13.6%, sterile shock 9.3%, and septic shoc k 20.2%. Patients with penetrating trauma had a significantly higher f requency of sepsis, severe sepsis, and septic shock (p < .01). The APA CHE II score, risk of death, and number of organ failures increased si gnificantly in both infective and noninfective groups with increasing severity of the inflammatory response. Sterile shock was associated wi th a significantly higher APACHE II score (p < .02), risk of death (p < .01), and number of organ failures (p = .03) compared with septic sh ock Only sterile shock was associated with a significantly higher ISS (p < .01). Organ system failure was significantly (p < .001) higher in nonsurvivors compared with survivors in all categories. The only sign ificant (p < .001) difference in mortality rate was found between pati ents in shock and all other categories. Conclusions: The current defin itions of SIPS, sepsis, and related disorders in critically injured pa tients without head trauma show a significant association with physiol ogic deterioration and increasing organ dysfunction. The only signific ant association with mortality, however, is the presence of shock. The definitions require refinement, with the possible inclusion of more o bjective gradations of organ system failure, if they are to be used fo r stratifying severity of illness in seriously injured patients.