Systemic Inflammatory Response Syndrome (SIRS): Drug Therapy

Therapy recommendations

Therapy for SIRS depends on the exact cause or previous illness:

• Surgical therapy of the underlying disease (focal decontamination) [see “Further Therapy”].
• Drug therapy:
  • Antimicrobial therapy
  • Supportive (“adjuvant”) therapy: intensive therapy, circulatory stabilization, volume therapy, insulin therapy, other supportive therapy, if necessary).
• Airway management/ventilation [see “Further therapy“].
• Renal replacement therapy, if necessary [see “Further therapy”]
• Nutrition [see “Further therapy”]

Drug therapy (antimicrobial therapy)

• Based on the bacteriological examinations (blood culture/blood cultures, smears, tissue samples, etc.).
• Start broad-spectrum antibiotics immediately after making the diagnosis (see “Sepsis/Medicinal Therapy” for details).
• Always complete first dose, then if necessary in renal / liver insufficiency (renal impairment / liver dysfunction or liver failure / failure of liver function) adjust dose.

Drug therapy (supportive therapy)

Arterial hypotension (systolic arterial blood pressure < 90 mmHg or mean arterial blood pressure < 70 mmHg for at least one hour).

• Volume therapy:
  • Crystalloid as well as colloidal solutionsNote: The Committee for Risk Assessment (PRAC) of the European Medicines Agency EMA advises after a review to withdraw the approval of hydroxyethyl starch (HES) in the EU.From April 17, 2019, HES may only be used by special institutions.(Communication: Federal Institute for Drugs and Medical Devices (BfArM))As an alternative for hypovolemia, crystalloid solutions (saline, bicarbonate, dextrose, Ringer) are available.
  • Red blood cell concentrates (blood products obtained from whole blood and consist mainly of red blood cells) in hemoglobin (Hb) values < 7 g/dl (target: 7-9 g/dl).
• Administration of catecholamines:
  • Norepinephrine in the presence of reduced systemic vascular resistance (vascular resistance).
  • Dobutamine in hypodynamic circulation (blood pressure drop/shock).
  • Vasopressin/Terlipressin if necessary in refractory circulatory instability.
  • Blood transfusion for hemoglobin levels (Hb; blood pigment) < 7-8 g/dl.

The following conditions should be met:

• The mean arterial pressure (MAP) should be > 65 mmHg. Early stabilization of the circulation (< 6h) reduces mortality (death rate)!
• Other parameters:
  • CVD (central venous pressure) 8-12 mmHg.
  • Central venous oxygen saturation (SvO2) ≥ 70%.
  • Urine volume ≥ 0.5 mg/kg bw/h

Intensified insulin therapy

• Recommend setting blood glucose levels between 90-150 mg/dl to reduce mortality (death rate).

Further supportive therapy

• Activated protein C to stabilize fibrinolysis (endogenous dissolution of a thrombus/blood clot) in the early phase of severe sepsis with multiple organ failure.
• Antithrombin (AT) III, if applicable.
• Glucocorticoids in case of hemodynamic instability.
• Other agents are currently the subject of various studies