Systemic Inflammatory Response Syndrome(SIRS)
Systemic Inflammatory Response Syndrome(SIRS)
JOAHNNA MARIE ABUYAN, RNSystemic Inflammatory Response
Syndrome(SIRS)
Is aninflammatory stateaffecting the whole body, frequently a
response of theimmune systemtoinfection, but not necessarily so. It
is related tosepsis, a condition in which individuals meet criteria
for SIRS and have a known infection.It is the body's response to an
infectious or noninfectious insult. Although the definition of SIRS
refers to it as an "inflammatory" response, it actually has pro-
and anti-inflammatory components.
EtiologyThe following is partial list of the infectious causes
of SIRS:Bacterial sepsisBurn wound
infectionsCandidiasisCellulitisCholecystitisCommunity-acquired
pneumonia[3]Diabetic foot infectionErysipelasInfective
endocarditisInfluenza
Intraabdominal infections - Eg, diverticulitis, appendicitisGas
gangreneMeningitisNosocomial pneumoniaPseudomembranous
colitisPyelonephritisSeptic arthritisToxic shock syndromeUrinary
tract infections (male and female0
The following is a partial list of the noninfectious causes of
SIRS:
Acute mesenteric ischemiaAdrenal insufficiencyAutoimmune
disordersBurnsChemical aspirationCirrhosisCutaneous
vasculitisDehydrationDrug reactionElectrical injuriesErythema
multiformeHemorrhagic shockHematologic malignancy
Intestinal perforationMedication side effect - Eg, from
theophyllineMyocardial infarctionPancreatitisSeizureSubstance abuse
- Stimulants such as cocaine and amphetaminesSurgical
proceduresToxic epidermal necrolysisTransfusion reactionsUpper
gastrointestinal bleedingVasculitis
In 1992, the American College of Chest Physicians (ACCP) and the
Society of Critical Care Medicine (SCCM) introduced definitions for
systemic inflammatory response syndrome (SIRS),sepsis, severe
sepsis,septic shock, and multiple organ dysfunction syndrome
(MODS).
The idea behind defining SIRS was to define a clinical response
to a nonspecific insult of either infectious or noninfectious
origin. SIRS is defined as 2 or more of the following variables
SIRS is nonspecific and can be caused by ischemia, inflammation,
trauma, infection, or several insults combined. Thus, SIRS is not
always related to infection.
Treatment and Management
Adequate fluid replacement for hypovolemiaIVF/NPO for
pancreatitisEpinephrine/steroids/diphenhydramine for
anaphylaxisLong-term antibiotics, when clinically indicated, should
be as narrow spectrum as possible to limit the potential for
superinfection (suggested by a new fever, a change in the white
blood cell [WBC] count, or clinical deterioration). Unnecessary
vascular catheters and Foley catheters should be removed as soon as
possible.
Patient education
Education should ideally target the patient's family. Family
members need to understand the fluid nature of immune
responsiveness and that SIRS is a potential harbinger of other more
dire syndromes.
Complications
Respiratory failure, acute respiratory distress syndrome (ARDS),
and nosocomial pneumoniaRenal failureGastrointestinal (GI) bleeding
and stress gastritisAnemiaDVTIntravenous catheterrelated
bacteremiaElectrolyte abnormalitiesHyperglycemiaDisseminated
intravascular coagulation(DIC) ShockMultiple organ dysfunction
syndrome
