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Rethinking the concept of sepsis and septic shock

      Highlights

      • Sepsis is a major global health problem and challenges physicians over the world.
      • Sepsis is now defined according to new definitions of Sepsis-3.
      • Sepsis-3 criteria demands the presence of organ disfunction thus delaying treatment.
      • SOFA criteria are too extensive and difficult to apply outside intensive care units.
      • An association of old SIRS and new qSOFA should be validated by adequate trials.

      Abstract

      Sepsis is a major global health problem and represents a challenge for physicians all over the world. The knowledge of sepsis and septic shock is a topic of interest among the scientific community and society in general.
      New guidelines for management of sepsis and septic shock were developed in 2016, providing an update on this area. In Sepsis-3 new definitions for sepsis and septic shock were published.
      The purpose of this narrative review is to discuss and compare the new criteria of 2016 with the old criteria, purposing at the same time an alternative approach for this topic. SOFA criteria (Sequential Organ Failure Assessment Score) are more complete, but too extensive and usually difficult to apply outside the intensive care units, therefore inducing potentially delay in the proper treatment.
      We purpose combined criteria for the selection of sepsis patients. Initially, we could apply qSOFA (quick Sepsis Related Organ Failure Assessment) criteria, due to its easy application, associated with the SIRS (systemic inflammatory response syndrome) criteria, allowing to select the patients who are infected and need faster treatment. In that way we would use the best of old and newest criteria, allowing the early selection of patients who are infected and require faster treatment, while the search for a better and faster tool continues.

      Keywords

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