24 Feb Hypotension and Elevated Lactate Levels are Cornerstones of Septic Shock Criteria
MedicalResearch.com Interview with:
Dr. Manu Shankar-Hari MB BS MD FRCA EDIC FFICM MSc[Epi]
Consultant, Intensive Care Medicine; Guy’s and
St Thomas’ NHS Foundation Trust
Clinical Research Associate, Intensive Care National Audit and Research Centre
Honorary Senior Lecturer in Intensive Care Medicine
Division of Asthma Allergy and Lung Biology
King’s College London, UK
Medical Research: What is the background for this study? What are the main findings?
Dr. Shankar-Hari: Septic shock is a complex illness. The previous Consensus Definitions (1991 and 2001) place emphasis on the circulatory abnormalities as the core concept and neither definitions provide data driven clinical criteria. In addition, last ten years of basic science research has established the concept that septic shock is associated with plethora of cellular and metabolic abnormalities (often referred to as cellular stress), alongside circulatory dysfunction.
In this background, the paper published in JAMA provides an updated illness concept (definitions) and data driven clinical criteria for diagnosing septic shock at the bedside.
The updated illness concept: ‘Septic shock is defined as a subset of sepsis in which underlying circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than sepsis alone.’
The clinical criteria: ‘Adult patients with septic shock can be identified using the clinical criteria of hypotension requiring vasopressor therapy to maintain mean arterial blood pressure 65 mm Hg or greater and having a serum lactate level greater than 2 mmol/L after adequate fluid resuscitation.’
Medical Research: What should clinicians and patients take away from your report?
Dr. Shankar-Hari Our message is septic shock is a complex illness with abnormalities in circulatory system and cellular stress. Septic shock is the most severe form of sepsis and carries a high mortality.
The proposed definition and clinical criteria provide a framework to harmonize what we label as septic shock Internationally.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Shankar-Hari: In health care settings where lactate measurement is not feasible, research to identify reliable alternative is a priority.
The paper provides septic shock definitions/ criteria and we did not assess management principles. Management of patients with sepsis and septic shock, should be guideline driven. We urge clinicians to continually evaluate the effectiveness of guideline driven process and identify ways to improve guideline compliance/outcomes from septic shock.
Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):775-787. doi:10.1001/jama.2016.0289.
Dr. Manu Shankar-Hari MB BS MD FRCA EDIC FFICM MSc[Epi] (2016). Hypotension and Elevated Lactate Levels are Cornerstones of Septic Shock Criteria