SIRS is an abbreviation for systemic inflammatory response syndrome. In the context of infections, medical science also refers to this immunologic whole-body inflammation as sepsis. Clearing the focus of inflammation is an important treatment step.
What is SIRS?
Inflammatory responses are signs of immunologic activation. Via immunologic inflammation, the immune system seeks to remove pathogens or other harmful substances from the body. Foreign substances, antigens, or abnormal tissue conditions trigger a stimulus that initiates the immunologic defense response. The particular inflammatory response may occur in affected organs and surrounding tissues or systematically affect the entire body. Ultimately, any stimulus above a physiologically normal level can activate inflammation. This applies to physical stimuli as well as mechanical stimuli. In addition to thermal, radiation, and chemical causes, inflammation can also be caused by allergens or autoallergens and actual pathogens such as viruses. SIRS stands for systemic inflammatory response syndrome, meaning an inflammatory response of the entire body. So instead of a local inflammation, systemic inflammatory response syndrome is a systemic inflammation that spreads throughout the body from a directly affected tissue. The clinical picture is similar to sepsis. However, unlike sepsis, no infections are detectable in SIRS.
Causes
Ultimately, sepsis is an infectious special form of SIRS. Systemic inflammatory response syndrome can thus be triggered by even more circumstances than sepsis, but it resembles it in its basic characteristics. The systemic inflammatory response without detectable infection may have an immunological cause. However, the clinical picture can also be caused by chemical correlations. For example, in acute pancreatitis, bile acid backs up into the pancreatic ducts, damaging the pancreatic epithelium or making it permeable to various substances. Thermal triggers are also possible causes of SIRS. These include burns above a certain size and severity. Among mechanical triggers, major surgery is one of the most important causes of SIRS. In particular, surgeries with an extracorporeal circuit are observed as triggers for the inflammatory reactions. However, in addition to cardiac surgery, large wound sites can also cause SIRS. Likewise, severe trauma, bleeding, ischemia, or anaphylaxis are possible triggers. Severe disease such as necrotizing pancreatitis is an equally conceivable cause of whole-body systemic inflammatory response.
Symptoms, complaints, and signs
Several parameters are indicative of SIRS. However, usually only about two of them are present on a patient at any one time. For example, criteria for diagnosis include a body temperature below 36 or above 38 degrees Celsius. The same applies to a heart rate above 90 per minute. Tachypneas with respiratory rates above 20 per minute and a paCO2 below 32 mmHg or oxygenation indices below 200 are also conceivable. A leukocyte count of less than 4000/mm3 or greater than 12000/mm3 may also be considered indicative of SIRS. The same is true for a less than ten percent immature leukocyte count. In the laboratory, hypophosphatemia and thrombocytopenia turn out to be additional markers of SIRS. Dramatic decreases in fibrinogen or factors II, V, and X may also provide clues to the clinical picture. CRP and ESR are usually highly positive and procalcitonin is in permanent elevation. Rising IL-6 and IL-8 are also indicative, as these are the main mediators of the acute-phase reaction.
Diagnosis and disease progression
The physician makes the diagnosis of SIRS on the basis of the above parameters. At least two of the above criteria must be met for diagnosis. The combination of fever and abnormal leukocytosis is the most common combination in diagnosing SIRS and refers to an appropriate or even exaggerated immune response. A body temperature below 36 degrees Celsius in combination with leukopenia is also called a cold SIRS and is indicative of an immune deficiency.If two or more of the above criteria If the SIRS is accompanied by a detectable infection, it is no longer referred to as systemic inflammatory response syndrome but as sepsis. The course depends strongly on the clinical picture in the individual case. Treatment as early as possible improves the prognosis. Initiation of therapy before detection of possible pathogens is considered the recommended standard.
Complications
As the disease progresses, SIRS can cause a number of symptoms and complications. Initially, the whole-body inflammation causes the body to overheat – resulting in symptoms such as fever and hyperventilation. If the body temperature rises above 41 degrees Celsius, life-threatening cardiovascular problems can occur. In the absence of treatment, circulatory collapse or heart failure will eventually occur. Accompanying symptoms such as dehydration and deficiency symptoms can also take a fatal course if left untreated. Due to the immune deficiency, there is also an increased risk of infections. This can cause inflammation throughout the body, which in the worst case can lead to blood poisoning. If the internal organs or the skin are affected, further complications arise, for example kidney failure and abscesses. The treatment is also associated with risks. For example, when antibiotics are administered, gastrointestinal complaints, headaches, muscle and limb pain, and skin irritations may occur. Allergies and intolerance reactions cannot be ruled out either. Infections, bleeding and injury to nerves can occur during surgical procedures. Allergic reactions to the substances and materials used may also occur in some cases.
When should you go to the doctor?
Medical treatment is definitely needed for SIRS. In the worst case, the affected person may also die due to the symptoms of the syndrome, so early diagnosis is very important. In most cases, the life expectancy of the patient is significantly reduced due to SIRS. A doctor should be consulted if the patient suffers from a body temperature that is clearly too low or clearly too high. This may be accompanied by very high-frequency breathing or gasping. Many affected persons suffer from fever or even a loss of consciousness. If these symptoms occur, a doctor should be consulted immediately. Reduced resistance of the immune system may also indicate this disease and should always be examined by a physician. In the first instance, a general practitioner can be consulted for SIRS. Further treatment is then usually carried out by a specialist. It is not always possible to predict whether treatment will be successful. In emergencies, the hospital should be visited or the emergency physician called.
Treatment and therapy
To treat SIRS, the first step is to identify the focus of inflammation. Once the focus of the inflammatory response has been detected, surgical intervention is performed to remediate the focus. Antibiotics are given initially and correspond to broad coverage according to suspicion. This step can be referred to as calculated therapy. An antibiogram is performed to elucidate any resistance. Then, if necessary, a switch is made to specified antibiotic therapy. The drug and surgical steps are rounded out with volume administration to establish a CVD above eight to twelve mmHg and a mean arterial pressure above 65 mmHg. If volume administration is not sufficient to achieve value, treatment with vasopressors or positive inotropic agents such as norepinephrine is considered as early as possible. Therapy pursues a central venous oxygen saturation of greater than 70 percent, which is maintained throughout the remainder of therapy. In addition, an ideal Hb concentration with a hematocrit above 24 to 30 percent is sought. If necessary, this value can be achieved by giving erythrocyte concentrate. Ventilation with a tidal volume of six milliliters per kilogram of body weight is used for lung protection, following the open-lung concept with PEEP above the inflection point.
Prevention
SIRS is a relatively natural reaction. Severe progressions can be prevented, if necessary, by prompt treatment. In particular, prompt clearing of the focus of inflammation can be described as a preventive measure.
Aftercare
Systemic inflammatory response syndrome (abbreviated as SIRS) affects the entire organism.If not treated, the syndrome can develop into life-threatening sepsis with organ failure. In addition to treatment of the underlying disease, medical follow-up is necessary. The aim is to avoid organic sequelae and septic shock. For a favorable course of the disease, therapy and aftercare must be provided in a timely manner within one day. The affected person receives antibiotic and/or anti-inflammatory drugs. With the help of the drugs, the inflammation should subside, and the vital functions must also be closely monitored. After emergency treatment, the patient should be out of danger of death. The care should prevent recurrence of SIRS. Further follow-up depends on the causative disease; it is initiated while the patient is still in the hospital. In the case of drug therapy, the specialist monitors the progress of healing. The aftercare ends with the healing. In the case of surgical treatment, it is scheduled for the medium to long term. After discharge from the hospital, the patient must visit his or her general practitioner at fixed intervals. There, the postoperative condition is determined. Follow-up care ends when the affected person is found to be stable.
Here’s what you can do yourself
Self-help options for this disorder are limited to taking measures to improve general well-being and strengthen the immune system. The patient’s organism can be supported with a balanced and vitamin-rich food intake. Sufficient oxygen, avoidance of environments with pollutants and a daily exercise in fresh air help the body to build up its defenses. To alleviate gastrointestinal complaints, it is important to have a food intake that is adapted to the patient’s needs. Alcohol, nicotine, a fatty diet or an excessive intake of food should be avoided. To stop muscle and limb pain, regular balancing movements, warming baths or massages are recommended. Physical overexertion should be avoided, as should one-sided or rigid postures. At the first signs of discomfort or indisposition, take breaks to give the body time to regenerate. In the case of headaches, it is advisable to remain calm and to reduce stressors as much as possible. Cognitive training can be used in everyday life to reduce emotional stress and promote inner balance. Various relaxation techniques also help to alleviate existing complaints. Although recovery does not occur, methods such as yoga or meditation can provide patients with an improvement in well-being in the area of self-help.
