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Are you Ernest Shackleton, the polar explorer? Refining the criteria for delirium
and brain dysfunction in sepsis
#MMPMID28286656
Rasulo FA
; Bellelli G
; Ely EW
; Morandi A
; Pandharipande P
; Latronico N
J Intensive Care
2017[]; 5
(?): 23
PMID28286656
show ga
The Third International Consensus Definitions for Sepsis and Septic Shock has
recently defined sepsis as a life-threatening organ dysfunction caused by a
dysregulated host response to infection. Organ dysfunctions in this consensus
definition were identified as an organ-specific Sequential [Sepsis-related] Organ
Failure Assessment (SOFA) score???2 points. The quick SOFA (qSOFA) considers
altered mentation indicating brain dysfunction when the Glasgow Coma Scale (GCS)
score is ?13 or ?14. However, concern has been expressed that the revised
criteria may lead to a failure in recognizing the signs of potentially lethal
organ dysfunction and thus sepsis. Patients with delirium have a fluctuating
course, and GCS can be normal or only slightly reduced at the time when signs of
delirium are already present. We here report an illustrative case showing how an
acute, initially unrecognized, urinary tract infection caused acute brain
dysfunction with profound behavioral and cognitive dysfunction despite normal
GCS, hence not meeting the criteria for sepsis.