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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Friday, February 6, 2015

SEPSIS en adulto mayor

ALiEM - February 5, 2015 - By Christina Shenvi MD PhD
"60% of patients in the United States who develop severe sepsis are older adults (age 65 and over) [1], and the mortality of severe sepsis increases steadily with age to nearly 40% in those over 85 [2]. There are many factors that make older adults more susceptible to sepsis, and that can also make sepsis more difficult to detect. Here are some tips to help explain why this is, and how you can identify it sooner.

  • Have a low threshold for considering sepsis and severe sepsis in older adults
  • Be aware that the SIRS criteria may not identify older adults with severe infections with the same sensitivity as in younger adults.
  • Use other criteria in addition to SIRS to make you think of sepsis or severe sepsis
    • Any signs of end organ injury
    • Elevated lactate or other lab abnormalities
    • Changes in mental status
    • Changes in urine output or continence
  • Be aggressive with treatment when appropriate. Except in cases where the patient or family have indicated that they do not want certain treatments or aggressive therapies, or when it is clearly medically futile (a difficult thing to ascertain at times), treat sepsis and severe sepsis aggressively. The surviving sepsis campaign has detailed recommendations for time-based treatment targets, but the key points are:
    • Early identification
    • Early fluids
    • Early antibiotics and source control"