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Síndrome de resposta inflamatória sistémica, sépsis e disfunção orgânica múltipla na prática clínica de animais de companhia
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A síndrome de resposta inflamatória sistémica (SIRS) e a sépsis são comuns e estão geralmente associadas a elevada morbilidade e mortalidade em cães e gatos. Identificar a causa subjacente da SIRS e, especificamente, diferenciar as causas infeciosas das não infeciosas da SIRS é vital para orientar o tratamento adequado e em tempo oportuno. A síndrome da disfunção orgânica múltipla (MODS) é um fenómeno multifatorial que ocorre secundariamente tanto à SIRS não infeciosa como à sépsis, e refere-se à presença de função orgânica alterada num doente agudo, de tal modo que a homeostase não possa ser mantida sem intervenção médica. Geralmente é a MODS que causa mortalidade em cães e gatos com SIRS e sépsis. A abordagem de diagnóstico a animais doentes com SIRS e sépsis inclui um exame físico completo, avaliações laboratoriais e imagens de diagnóstico. O tratamento para SIRS e sépsis inclui uma abordagem de fluidoterapia de choque, cuidados de suporte vital e gestão da disfunção dos órgãos. O tratamento para a sépsis também deve incluir terapia antimicrobiana adequada para controlo do foco infecioso, quando possível. O prognóstico para cães e gatos com SIRS e sépsis é variável, mas a presença de disfunções múltiplas de órgãos é normalmente um mau indicador prognóstico. Esta revisão bibliográfica pretende esclarecer conceitos, padronizar critérios e discutir a sua aplicabilidade no diagnóstico, tratamento e monitorização da síndrome de resposta inflamatória sistémica (SIRS) em animais de companhia.
Systemic inflammatory response syndrome (SIRS) and sepsis are common and are associated with high morbidity and mortality in dogs and cats. Identifying the underlying cause of SIRS and specifically differentiating infectious from non-infectious causes of SIRS is vital to guide timely and appropriate treatment. Multiple organ dysfunction syndrome (MODS) is a multifactorial phenomenon that occurs secondary to both non-infectious SIRS and sepsis and refers to the presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without medical intervention. It is usually MODS that causes mortality in dogs and cats with SIRS and sepsis. The diagnostic approach to animals with SIRS and sepsis includes a thorough physical examination, laboratory evaluations, and diagnostic imaging. Treatment for SIRS and sepsis includes an approach of shock fluid therapy, life support care, and management of organ dysfunction. Treatment for sepsis should also include appropriate antimicrobial therapy to control the infectious focus when possible. The prognosis for dogs and cats with SIRS and sepsis is variable, but the presence of multiple organ dysfunction is usually a poor prognostic indicator. This literature review aims to clarify concepts, standardize criteria, and discuss their applicability in the diagnostic, treatment and monitoring of SIRS in companion animals.
Systemic inflammatory response syndrome (SIRS) and sepsis are common and are associated with high morbidity and mortality in dogs and cats. Identifying the underlying cause of SIRS and specifically differentiating infectious from non-infectious causes of SIRS is vital to guide timely and appropriate treatment. Multiple organ dysfunction syndrome (MODS) is a multifactorial phenomenon that occurs secondary to both non-infectious SIRS and sepsis and refers to the presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without medical intervention. It is usually MODS that causes mortality in dogs and cats with SIRS and sepsis. The diagnostic approach to animals with SIRS and sepsis includes a thorough physical examination, laboratory evaluations, and diagnostic imaging. Treatment for SIRS and sepsis includes an approach of shock fluid therapy, life support care, and management of organ dysfunction. Treatment for sepsis should also include appropriate antimicrobial therapy to control the infectious focus when possible. The prognosis for dogs and cats with SIRS and sepsis is variable, but the presence of multiple organ dysfunction is usually a poor prognostic indicator. This literature review aims to clarify concepts, standardize criteria, and discuss their applicability in the diagnostic, treatment and monitoring of SIRS in companion animals.
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SIRS MODS SOFA qSOFA