The influence of sepsis and multisystem and organ failure on mortality in the surgical intensive care unit

The common causes of death in the surgical intensive care unit (SICU) are infection, hemorrhage, and central nervous system trauma. Due to recent technological advances, many patients now survive the initial metabolic insult only to develop multisystem and organ failure (MSOF). The influence of sepsis on the patients with MSOF leads to a fatal outcome in the majority of cases. A retrospective analysis of 45 patients who died of sepsis and MSOF during 1981 and 1982 was performed. These patients comprised 58 per cent of 77 patients who died of MSOF. Demographic data from these 45 patients and from 32 nonseptic patients who also died of MSOF were compared, and no significant differences were noted. In 78 per cent of the patients who died of sepsis and MSOF, the main source of infection was either the respiratory or gastrointestinal tract. Skin contamination and catheter sepsis were identified in 13 per cent of patients as the main source of infection. Sixty four per cent of patients had positive blood cultures, and at least 50 per cent of those had more than one positive culture site. Predominant organisms isolated were gram-negative bacilli and gram-positive cocci. With the exception of Clostridia in two cases, no positive anaerobic cultures were noted in these patients. When the septic and nonseptic patients were compared, certain factors were identified that may have influenced the development of sepsis in these patients. These factors were poor nutritional status, diabetes mellitus, use of steroids, previous splenectomy, and an average total lymphocyte count below 700.(ABSTRACT TRUNCATED AT 250 WORDS)