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Systemic Inflammatory Response Syndrome After Cardiac SurgerySystemic Inflammatory Response Syndrome: Time for a Change

Matthew W. Semler, MD; Arthur P. Wheeler, MD, FCCP
Author and Funding Information

From the Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center.

Correspondence to: Arthur P. Wheeler, MD, FCCP, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, T-1210 MCN, Nashville, TN 37232-2650; e-mail: art.wheeler@vanderbilt.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Wheeler receives National Institutes of Health National Heart, Lung, and Blood Institute grant funding and royalties from a textbook that he coauthored, and serves as a paid consultant to Cumberland Pharmaceuticals Inc. Dr Semler has reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(6):1181-1182. doi:10.1378/chest.14-0438
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In 1991, Bone et al1 defined the systemic inflammatory response syndrome (SIRS) as a selected set of physiologic and laboratory abnormalities occurring after a clinical insult. It was widely believed then that both infectious and noninfectious inflammation shared a pathophysiologic basis that might be amenable to early application of common treatments. By proposing the paradigm, his group aimed to (1) improve early detection and intervention, (2) improve prognostic assessment, and (3) standardize enrollment into clinical trials.1 The latter two goals were realized: In patients with SIRS from infection (sepsis), the relationship between an increasing number of SIRS criteria and worse prognosis was confirmed2; SIRS also became part of standard inclusion criteria for clinical trials of sepsis.3,4 However, the utility of SIRS to facilitate sepsis recognition never reached expectations, handicapped by oversensitivity and underspecificity.5,6

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