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




Tuesday, July 5, 2016

Pathophysicologic Approach to qSOFA

emDocs - July 4, 2016 - Author: Schnittke N -  Edited by: Koyfman A and Long B
"Closing thoughts
For centuries, we have defined sepsis in terms of its clinical features. Sepsis 3 takes a radically different approach: it defines the physiologic essence of sepsis and works backwards to define the clinical features of sepsis. While the resultant clinical features of qSOFA seem intuitive, they are pathophysiologically complex: a complexity that is congruent with the definition of life-threatening organ dysfunction caused by infection.
Although this consortium of critical care physicians “unanimously considered SIRS to be unhelpful”, it is difficult to abandon SIRS altogether. SIRS will continue to help us suspect significant infection and it will be a component of CMS sepsis core measures for some time, however it does not identify life-threatening organ dysfunction very specifically. In order to understand how sick a patient captured by the broad net of SIRS might be, qSOFA provides us with a tool to judge the severity of illness in these patients. While prospective validation is needed to assess its utility in guiding clinical decision making, this tool includes several key features, which are grounded in pathophysiology. These features are frequently overlooked in the ED setting, and it’s up to us to start taking these symptoms seriously.
Finally, Sepsis 3 and qSOFA have many weaknesses spelled out elsewhere. However, this is a strong attempt to bring the understanding of sepsis into the modern era of medicine. An era that demands an understanding of the underlying mechanisms of disease. As our understanding becomes more sophisticated we should be able to improve on this definition. Despite its flaws, Sepsis 3 still provides a significant improvement over older definitions, and should not be ignored just because our current “usual care” is just as good as “aggressive care” in losing a quarter of the lives affected by this life-threatening condition."