Systemic inflammatory response syndrome is characterised by
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The concept of a systemic inflammatory response syndrome (SIRS) to describe the complex pathophysiologic response to an insult such as infection, trauma, burns, pancreatitis, or a variety of other injuries came from an American College of Chest Physicians/Society of Critical Care Medicine-sponsored sepsis definitions consensus conference held in Chicago, IL in August 1991.1 The conference participants were charged with the task of defining an easy to apply set of clinical parameters to aid in the early identification of potential candidates to enter into clinical trials to investigating new innovative treatment strategies for sepsis. There was recognition that there was a great deal of ambiguity and lack of clarity in the current clinical definition of sepsis used in clinical discussions, design of research trials, and communication in the medical literature.1-4 The explosion of new advancements in the field of biotechnology coupled with an enhanced understanding of the complex pathophysiologic processes felt to be responsible for the clinical syndrome known as sepsis, gave birth to a plethora of new agents designed to inhibit, bind, block, or neutralize the villainous mediators that were felt to be responsible for the network of events that culminated in the clinical manifestations and organ dysfunction(s) seen in the septic patient.5-7 It was also anticipated that the use of these new strategic “antimediators, receptor blockers, anti-inflammatory agents, etc.” would improve patient survival and decrease morbidity in the critically ill infected patient.5,6 Most researchers in the field recognized the importance of interrupting these inflammatory pathways as early as possible in order to achieve success and it was therefore necessary to have the ability to recognize the septic patient at the earliest possible time point, if this strategy was going to have a potential to produce the desired benefit. This premise was the major goal of the 1991 consensus conference.1 This discussion will focus on the rationale for the SIRS definition, the application of SIRS in clinical research and patient management, the potential benefits associated with using the definition, the emergence of the term systemic inflammatory response syndrome (SIRS), and speculation as to the future of the SIRS definition. This review will only discuss the sepsis and SIRS definition in adults over the age of 18, as the complex and changing physiology of young children pose additional challenges to using target heart rates, respiratory rates, and other clinical parameters in the definition.