Systemic Inflammatory Response

Syndrome (SIRS)

JOAHNNA MARIE ABUYAN, RN
Systemic Inflammatory Response
Syndrome (SIRS)

Is an inflammatory state affecting the whole body,
frequently a response of the immune
system to infection, but not necessarily so.
It is related to sepsis, 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.


Etiology
The following is partial list of the infectious
causes of SIRS:
Bacterial sepsis
Burn wound infections
Candidiasis
Cellulitis
Cholecystitis
Community-acquired pneumonia[3]
Diabetic foot infection
Erysipelas
Infective endocarditis
Influenza

Intraabdominal infections - Eg,
diverticulitis, appendicitis
Gas gangrene
Meningitis
Nosocomial pneumonia
Pseudomembranous colitis
Pyelonephritis
Septic arthritis
Toxic shock syndrome
Urinary tract infections (male and
female0


The following is a partial list of the
noninfectious causes of SIRS:

Acute mesenteric ischemia
Adrenal insufficiency
Autoimmune disorders
Burns
Chemical aspiration
Cirrhosis
Cutaneous vasculitis
Dehydration
Drug reaction
Electrical injuries
Erythema multiforme
Hemorrhagic shock
Hematologic malignancy

Intestinal perforation
Medication side effect - Eg, from
theophylline
Myocardial infarction
Pancreatitis
Seizure
Substance abuse - Stimulants such as
cocaine and amphetamines
Surgical procedures
Toxic epidermal necrolysis
Transfusion reactions
Upper gastrointestinal bleeding
Vasculitis



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 hypovolemia
IVF/NPO for pancreatitis
Epinephrine/steroids/diphenhydramine for anaphylaxis
Long-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
pneumonia
Renal failure
Gastrointestinal (GI) bleeding and stress gastritis
Anemia
DVT
Intravenous catheterrelated bacteremia
Electrolyte abnormalities
Hyperglycemia
Disseminated intravascular coagulation (DIC)
Shock
Multiple organ dysfunction syndrome