Table 1 Definitions of sepsis and severe and irreversible organ system dysfunction
System or syndrome | Severe | Irreversible |
|---|---|---|
Sepsis* | Documentation of confirmed or strongly suspected infection and antibiotic use at time of death or within 24 h prior to withdrawal of life support | Septic shock evidenced by documentation of confirmed or strongly suspected infection with mean arterial pressure (MAP) < 65 mmHg† (or) on vasopressors unresponsive to antibiotics (and) no possible surgical intervention. Option was given to apply irreversible dysfunction if care was withdrawn due to poor prognosis related to sepsis. |
Pulmonary° | Inability to liberate from mechanical ventilation, non-invasive ventilation, or heated high flow nasal cannula due to inadequate oxygenation or ventilation without aforementioned support | Insupportable oxygenation or ventilation defined as PaO2 < 40 mmHg on FIO2–1.0 for > 2 h or respiratory acidosis with pH < 7.1 on maximum ventilator settings∞. Option was given to apply irreversible dysfunction if care was withdrawn due to poor prognosis related to pulmonary organ system dysfunction. |
Cardiac | Either cardiac output < 2.0 L/min/m2 or documented cardiogenic shock or reversible ventricular fibrillation or asystole | Cardiogenic shock or arrhythmia not responsive to treatment. Option was given to apply irreversible dysfunction if care was withdrawn due to poor prognosis related to cardiac organ system dysfunction. |
Neurologic | Glasgow coma scale < 8 for ≥ 3 days | Meets brain death criteria. Option was given to apply irreversible dysfunction if care was withdrawn due to poor prognosis related to neurologic organ system dysfunction. |
Hematologic | Microvascular bleeding with either fibrinogen < 100 mg/dL, prothrombin time and partial thromboplastin time > 1.5 times control, or platelets < 60,000/μL | Ongoing microvascular bleeding not surgically correctable with MAP < 65 mmHg not reversible with blood products. Option was given to apply irreversible dysfunction if care was withdrawn due to poor prognosis related to hematologic organ system dysfunction. |
Hemorrhage | MAP < 65 mmHg for > 2 h (or requiring vasopressors) necessitating blood transfusions and excluding other causes of hypotension | Uncontrollable “surgical” bleeding from a non-microvascular source. Option was given to apply irreversible dysfunction if care was withdrawn due to poor prognosis related to hemorrhage. |
Hepatic | Bilirubin > 5.0 mg/dL and albumin < 2.0 g/dL and prothrombin time or partial thromboplastin time > 1.5 times control | Severe criteria plus hepatic encephalopathy and/or hepatorenal syndrome not responsive to treatment. Option was given to apply irreversible dysfunction if care was withdrawn due to poor prognosis related to hepatic organ system dysfunction. |
Gastrointestinal | Resectable ruptured or necrotic bowel, or pancreatitis causing shock (MAP < 65 mmHg for > 2 h or requiring vasopressors) | Inoperable ruptured or necrotic bowel or pancreatitis causing irreversible shock. Option was given to apply irreversible dysfunction if care was withdrawn due to poor prognosis related to gastrointestinal organ system dysfunction. |
Renal | Either creatinine > 5.0 mg/dL or requiring hemodialysis | Renal failure with acidosis, hyperkalemia, and/or hypercalcemia causing irreversible cardiac arrest. Option was given to apply irreversible dysfunction if care was withdrawn due to poor prognosis related to renal organ system dysfunction. |