Systemic Inflammatory Response Syndrome (SIRS): Therapy

The therapy of SIRS is complex. In addition to “Drug Therapy,” which is one of the mainstays, “Causal Therapy” and “Supportive Therapy” (for hemodynamic stabilization, see “Drug Therapy”) are of great importance.

Causal therapy

Surgical therapy if necessary. focal therapy:

The basic prerequisite for successful therapy is surgical therapy of the underlying disease or, if available, complete early sanitation of a source of infection. Depending on the source, this may involve removal of foreign bodies, placement of drains, miracle opening, etc.

Supportive therapy

Renal replacement procedures

  • Administration of diuretics should be considered only to test the kidney after adequate volume therapy has been given
  • Early initiation of continuous veno-venous hemofiltration (CVVH) if urine output <30 ml/h persists for more than three hours despite optimal volume therapy or pulmonary hyperhydration; CVVH is equivalent to intermittent hemodialysis; CVVH is recommended in hemodynamically unstable patients because of better tolerability

Airway management/ventilation

  • Pulse oxymetrically measured oxygen saturation (SpO2) should be > 90%.
  • Patients with severe sepsis/septic shock should be ventilated at an early stage
  • The following parameters should be adhered to:Controlled ventilation:
    • Tidal volume (breath volume, or AZV; is the set volume applied per breath): 6 ml/kg standard body weight
    • Plateau pressure (measure of end-inspiratory pressure in alveoli in a flow-free phase): < 30 cm H2O.
    • Oxygen saturation (SpO2): > 90%.
  • PEEP (engl.: positive end-expiratory pressure; positive end-expiratory pressure) as a function of FiO2 (indicates how high the O2 content in the breathing air is).
  • In cases of severe oxygenation disorders (disorders in the supply of oxygen), the abdominal positioning or 135° positioning should be performed
  • Weaning (to wean; or ventilator weaning is the phase of weaning a ventilated patient from the ventilator is called) should be started as soon as possible

Nutrition

  • Early initiation of normal nutrition to prevent atrophy (regression) of the intestinal villi and to increase the secretion of IgA: all patients who are not expected to be fully nourished with normal diet within three days should receive artificial nutrition (enteral/delivery of nutrition via the intestine or parenteral nutritionreceipt (delivery bypassing the intestine, e.g., intravenously, i.e., via the vein).
  • An oral or enteral nutrition receives in principle the preference over parenteral nutrition.
  • Patients with severe sepsis/septic shock should be given 30-50% of non-protein calories as fat; these should not contain exclusively long-chain triglycerides; immunonutrition cannot be recommended
  • Enteral nutrition should be composed as follows:
    • 25-30 kcal/kg bw
    • Amino acids 15-20 %
    • Carbohydrates 50-70 %
    • Fats 15-30 %
  • A diet with omega-3 fatty acids in combination with antioxidants can be considered
  • Glutamine dipeptide should be added to parenteral nutrition alone; glutamine should not be provided enterally in patients with severe sepsis/septic shock
  • Selenium (initial study results are promising regarding a reduction in mortality/mortality).
  • Stress ulcer prophylaxis with histamine-2 receptor blockers or proton pump inhibitors is recommended

Other supportive therapy

  • Temperature lowering to reduce peripheral oxygen consumption.