Septic Shock

Legacy Content

This page is about the pre-ICD10 diagnosis coding schema. See the ICD10 Diagnosis List, or the following for similar diagnoses in ICD10:Shock, septic

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Category/Organ System:	Category: Cardiovascular Problems (old)
Type:	[[:Category: Medical Problem (old)]][[Category: Medical Problem (old)]]
Main Diagnosis:	Septic Shock
Sub Diagnosis:	SEPTIC SHOCK
Diagnosis Code:	Septic Shock - 4400
Comorbid Diagnosis:	No
Charlson Comorbid coding (pre ICD10):	0
Program:	Critical Care and Medicine
Status:	Currently Collected

Mutually exclusive with Severe Sepsis

Also see Septicemia definition.

See QA Septic Shock audit started September 2009.

Definition

(1) Blood pressure (BP) criteria

• If at least one of the following is present, code Septic Shock:
  • systolic BP < 90 mmHg for > 30 minutes and not responding to fluid resuscitation or
  • mean (m)BP < 65 mmHg (is this an "and" to the next line?)
  • BP drop of > 40 mmHg from baseline for > 30 min or
  • use of vasopressor to maintain systolic BP >= 90 mmHg in the absence of other causes of shock, e.g.:
    • no hypovolemia
    • no MI
    • no pulmonary embolus
• If none of the BP criteria are met:
  • see Severe Sepsis

(2) Other Criteria

Plus at least two of:

• temperature > 38.5 C
• HR > 90
• RR > 20

(3) Organ Failure Criteria

Plus at least one of (organ failure):

• Neuro changes: GCS < 14
• Lactic Acidosis: at least one of
  • LA > 2.0 or
  • PH < 7.30 or
  • BE < 10
• Oliguria: at least one of
  • urine < 0.5 cc/kg/hr or
  • urine output < 30 ml / hr or
  • serum creatinine increase > 40 uM from baseline
• Hypoxia: at least one of
  • PaO2 < 75 on RA or
  • PaO2 / FiO2 ratio <280 (not valid due to pneumonia)
• Coagulopathy: drop in platelets > 25% from baseline plus at least one of
  • > 25% PT or
  • > 25% PTT or
  • NR >1.5

Notes

• a positive culture is not required for septic shock
• you can use septic shock to code distributive shock unless it can be coded more accurately:
  • causes for distributive shock that should not be coded as septic shock are:
    • Anaphylactic Shock
    • Neurogenic or Spinal Shock

Data Integrity Rules

Septic shock (44-00) is mutually exclusive with 45-00 Severe Sepsis.