Also known as SIRS, Systemic Inflammatory Response Syndrome (SIRS) is a pathological condition that carries an increased risk of severe consequences for the patient. SIRS is possible against the background of surgical interventions, which are currently extremely widespread, in particular, when it comes to malignant pathologies. Other than surgery, the patient cannot be cured, but intervention can provoke SIRS.
Features of the issue
Since systemic inflammatory response syndrome in surgery occurs more often in patients who were treated against the background of general weakness, illness, the likelihood of a severe course is determined by the side effects of other therapeutic methods used in a particular case. Regardless of where exactly the injury caused by the operation is located, the early rehabilitation periodcarries an increased risk of secondary damage.
As is known from pathological anatomy, systemic inflammatory response syndrome is also due to the fact that any operation provokes inflammation in an acute form. The severity of such a reaction is determined by the severity of the event, a number of auxiliary phenomena. The more unfavorable the background of the operation, the more difficult it will be for VSV.
What and how?
Systemic inflammatory response syndrome is a pathological condition that indicates itself tachypnea, fever, heart rhythm disturbance. Analyzes show leukocytosis. In many ways, this response of the body is due to the peculiarity of the activity of cytokines. Pro-inflammatory cellular structures that explain SIRS and sepsis form the so-called secondary wave of mediators, due to which systemic inflammation does not subside. This is associated with the danger of hypercytokinemia, a pathological condition in which damage is done to the tissues and organs of one's own body.
The problem of determining and predicting the probability of occurrence of systemic inflammatory response syndrome, in the ICD-10 coded R65, in the absence of a suitable method for assessing the initial state of the patient. There are several options and gradations that allow you to determine how bad a patient's he alth condition is, but none of them is linked to the risks of SIRS. It is taken into account that in the first 24 hours after the intervention, SIRS appears without fail, but the intensity of the condition varies - this is determined by a complex of factors. If the phenomenon is severe, prolonged,increases the likelihood of a complication, pneumonia.
About terms and theory
Systemic inflammatory response syndrome, coded as R65 in the ICD-10, was considered in 1991 at a conference bringing together leading experts in intensive care and pulmonology. It was decided to recognize SIRS as a key aspect, reflecting any inflammatory process of an infectious nature. Such a systemic reaction is associated with the active distribution of cytokines, and it is not possible to take this process under control by the forces of the body. Inflammatory mediators are generated in the primary focus of infectious infection, from where they move to the tissues around, thus entering the circulatory system. The processes proceed with the involvement of macrophages, activators. Other tissues of the body, remote from the primary focus, become the area of generation of similar substances.
The most common inflammatory mediator, according to the pathophysiology of systemic inflammatory response syndrome, is histamine. Similar effects have factors that activate platelets, as well as those associated with necrotic tumor processes. Perhaps the participation of adhesive molecular structures of the cell, parts of the complement, nitric oxides. SIRS can be explained by the activity of poisonous products of oxygen transformation and lipid peroxidation.
Pathogenesis
Recorded by the R65 code in the ICD-10, systemic inflammatory response syndrome occurs when a person's immunity cannot take control and extinguishactive systemic dissemination of factors initiating inflammatory processes. There is an increase in the content of mediators in the circulatory system, which leads to a failure of fluid microcirculation. The capillary endothelium becomes more permeable, poisonous components from the bed penetrate through the cracks of this tissue into the cells surrounding the vessels. Over time, inflamed foci appear remote from the primary area, a gradually progressive insufficiency of the work of various internal structures is observed. As a result of such a process - DIC syndrome, paralysis of immunity, insufficiency of functioning in a multiple organ form.
As shown by numerous studies on the occurrence of systemic inflammatory response syndrome in obstetrics, surgery, oncology, such a response appears both when an infectious agent enters the body, and as a response to a certain stress factor. SIRS can be triggered by somatic pathology or a person's injury. In some cases, the root cause is an allergic reaction to a medication, ischemia of certain parts of the body. To some extent, SIRS is such a universal response of the human body to unhe althy processes occurring in it.
Subtleties of the issue
Studying the systemic inflammatory response syndrome in obstetrics, surgery, and other branches of medicine, scientists paid special attention to the rules for determining such a condition, as well as the intricacies of using various terminologies. In particular, it makes sense to talk aboutsepsis, if the infectious focus becomes the cause of inflammation in a systemic form. In addition, sepsis is observed if the functioning of some parts of the body is disrupted. Sepsis can be diagnosed only with the obligatory selection of both signs: SIRS, infection of the body.
If manifestations are observed that allow one to suspect dysfunction of internal organs and systems, that is, the reaction has spread wider than the primary focus, a severe variant of the course of sepsis is detected. When choosing a treatment, it is important to remember the possibility of transient bacteremia, which does not lead to a generalization of the infectious process. If this has become the cause of SIRS, organ dysfunction, it is necessary to choose a therapeutic course indicated for sepsis.
Categories and severity
Based on the diagnostic criteria for the systemic inflammatory response syndrome, it is customary to distinguish four forms of the condition. Key signs that allow you to talk about SIRS:
- fever above 38 degrees or temperature below 36 degrees;
- heart beats at over 90 beats per minute;
- breathing in frequency exceeds 20 acts per minute;
- with ventilator RCO2 less than 32 units;
- leukocytes in the analysis are defined as 1210^9 units;
- leucopenia 410^9 units;
- new leukocyte forms more than 10% of the total.
To be diagnosed with SIRS, the patient must have two or more of these signs.
About options
If the patient has two or more signs of the above manifestationssystemic inflammatory response syndrome, and studies show the focus of infection, analysis of blood samples gives an idea of the pathogen that caused the condition, sepsis is diagnosed.
In case of insufficiency developing according to a multi-organ scenario, in case of acute failures of the patient's mental status, lactic acidosis, oliguria, pathologically severely reduced blood pressure in the arteries, a severe form of sepsis is diagnosed. The condition is maintained through intensive therapeutic approaches.
Septic shock is detected if sepsis develops in a severe form, low blood pressure is observed in a stable variant, perfusion failures are stable and cannot be controlled by classical methods. In SIRS, hypotension is considered to be a condition in which the pressure is less than 90 units or less than 40 units relative to the initial state of the patient, when there are no other factors that can provoke a decrease in the parameter. It is taken into account that the intake of certain medications may be accompanied by manifestations indicating organ dysfunction, perfusion problem, while the pressure is maintained adequately.
Could it get worse?
The most severe course of the systemic inflammatory response syndrome is observed if the patient has impaired functionality of a pair or more organs necessary to maintain viability. This condition is called multiple organ failure syndrome. This is possible if SIRS is very severe, while medicationand instrumental methods do not allow to control and stabilize homeostasis, with the exception of methods and methods of intensive treatment.
Development Concept
At present, a two-phase concept is known in medicine to describe the development of SIRS. The cytokine cascade becomes the basis of the pathological process. At the same time, cytokines that initiate inflammatory processes are activated, and with them mediators that inhibit the activity of the inflammatory process. In many ways, how the systemic inflammatory response syndrome will proceed and develop is determined precisely by the balance of these two components of the process.
SIRS is progressing through the stages. The first in science is called induction. This is the period during which the focus of inflammation is local, due to a normal organic reaction to the impact of some aggressive factor. The second stage is a cascade, in which too many inflammatory mediators are generated in the body that can penetrate the circulatory system. At the third stage, secondary aggression takes place, directed at one's own cells. This explains the typical course of the systemic inflammatory response syndrome, early manifestations of insufficient organ functionality.
The fourth stage is immunological paralysis. At this stage of development, a deeply depressed state of immunity is observed, the work of the organs is very much disturbed. The fifth and final stage is the terminal one.
Can anything help?
If you need reliefduring the course of the systemic inflammatory response syndrome, the clinical recommendation is to monitor the patient's condition, regularly taking indicators of the work of vital organs, and also to use medications. If necessary, the patient is connected to special equipment. Recently, medications designed specifically for the relief of SIRS in its various manifestations look especially promising.
Effective drugs for SIRS based on diphosphopyridine nucleotide, also include inosine. Some versions of the release contain digoxin, lisinopril. Combination medications, chosen at the discretion of the attending physician, inhibit SIRS, regardless of what caused the pathological process. Manufacturers assure that a pronounced effect can be achieved in the shortest possible time.
Do I need surgery?
Additional surgery may be prescribed for SIRS. Its necessity is determined by the severity of the condition, its course and development forecasts. As a rule, it is possible to carry out an organ-preserving intervention, during which the area of suppuration is drained.
Drugs in detail
The identification of the medicinal properties of diphosphopyridine nucleotide combined with inosine has given physicians new opportunities. Such a drug, as practice has shown, is applicable in the work of cardiologists and nephrologists, surgeons and pulmonologists. Preparations with this composition are used by anesthesiologists, gynecologists, endocrinologists. Currentlydrugs are used in surgical operations on the heart and blood vessels, if necessary, to provide assistance to the patient in the intensive care unit.
Such a wide area of use is associated with the general symptoms of sepsis, the consequences of burns, manifestations of diabetes occurring in a decompensated handicap, shock on the background of trauma, SDS, necrotic processes in the pancreas and many other severe pathological uprisings. The symptom complex inherent in SIRS, and effectively stopped by diphosphopyridine nucleotide in combination with inosine, includes weakness, pain, and sleep disturbances. The drug relieves the condition of a patient who has a headache and dizziness, symptoms of encephalopathy appear, the skin turns pale or yellow, the rhythm and frequency of heart contractions are disturbed, and blood flow fails.
Relevance of the issue
As shown by statistical studies, SIRS is currently one of the most common options for the development of severe hypoxia, a strong destructive activity of cells in individual tissues. In addition, such a syndrome with a high degree of probability develops against the background of chronic intoxication. Pathogenesis, etiology of conditions leading to SIRS differ greatly.
With any shock, there is always a SIRS. The reaction becomes one of the aspects of sepsis, a pathological condition caused by trauma or burns. It cannot be avoided if the person has had a TBI or surgery. As observations have shown, SIRSis diagnosed in patients with diseases of the bronchi, lungs, uremia, oncology, surgical pathological conditions. It is impossible to exclude SIRS if an inflammatory or necrotic process develops in the pancreas, abdominal cavity.
As shown by specific studies, SIRS is also observed in a number of more favorably developing diseases. As a rule, with them, this condition does not threaten the patient's life, but lowers its quality. We are talking about heart attack, ischemia, hypertension, preeclampsia, burns, osteoarthritis.
