BY

DR.VIJAYANAND PALANISAMY

complete blood cell count with differential to evaluate for leukocytosis or leucopenia

Sedimentation rates and C-reactive proteins are not sensitive in distinguishing between causes of SIRS but may be helpful in certain circumstances

Lung receives whole output of right side of heart . Hence lungs is more susceptable to injury than other organs

Ref value <0.5ng/ml

In an observational, prospective study in a pediatric ICU, Arkader et al showed that PCT levels could be used to differentiate between infectious and noninfectious SIRS, while C-reactive protein (CRP) levels could not

Raise in bacterial infection

Their lack of routine availability in most hospitals limits their usefulness.

produced by monocytes, lymphocytes, and endothelial cells

stimulates an adhesive neutrophil-cardiac myocyte interaction and induces myocardial damage following CPB surgery

normal value <28 pg/ml and >300pg/ml – sirs

In addition, a decrease in IL-6 by the second day of antibiotic treatment has been shown to be a marker of effectiveness of therapy and a positive prognostic sign in those patients with an infectious etiology for their SIRS

Interleukin 8 monocytes, polymorphonuclear (PMN) leukocytes,

macrophages, fibroblasts, and vascular endothelial cells

induces the amplification of neutrophils and macrophages

regulate neutrophil transendothelial migration, and potentially to control neutrophil-mediated tissue injury

Interleukin 10counter antiinflammatory response syndrome

(CARS)

NEOPTERIN - Ref value <12.5nM

Serum phosphate level – hypophosphatemia (inversely correlates with proinflammatorycytokines level )

Leucocyte count - Ref value 4000-12000

C-reactive protein - Ref value <5mg/l

Leucocyte elastase - Ref value <32mcg/l

sL-selectin - Ref value 1250 ng/ml

sCD-14-Ref value <4.5mcg/ml

Leptin - cutoff of 38 µg/L (correlates well with serum IL-6 and tumor necrosis factor–alpha (TNF- α ) levels)

The aPTT wave form analysis was performed with the MDA II analyzer. In the aPTT assay, the slope of the initial phase of the light transmission profile quantifies an abnormal BPW. BPW signal unit is transmittance percentage per second (%T/s).

The BPW is caused by calcium-dependent formation between VLDL and CRP .

independent of the aPTT clotting

Statin therapy reduce chance of developing BPW

fever and other SIRS criteria have a low specificity (e.g. burns, pancreatitis, transfusion)

elderly, immunocompromised and malnourished patients do not manifest typical signs of sepsis or SIRS

both infective and noninfective SIRS can

co-exist in same patient

some of the clinical criteria applies to adult physiological variables

early administration of antibiotics is important in management but decreases diagnostic yield

delay in diagnosis (time until culture results available)

specimens are easily contaminated

PCR tests are not universally available

biomarkers such as CRP, IL-6 and procalcitoninhave limited sensitivity & specificity and cannot be used in isolation

Transient rise in Heart rate ,breathing frequency , and signs of hyperventilation results from suctioning and inadequate sedation and analgesia

Transient raise in heart rate in case of pain, change in inotropic support , alteration in preload or afterload , or as patient getting awake.

Heart rate will be low because of betablockingin postop period.

Temperature of patient is influenced by ICU/OR temperature , Blood transfusion , cardiac status , thyroid status , vasodilators/constrictors and so on

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