New concepts in treatment of sepsis.

le Roux P. (2004)

Article

Critically ill patients still commonly die of the effects of sepsis, despite numerous interventions. Earlier trials investigated mostly anti-inflammatory strategies, based on the prevailing theory that sepsis represents an uncontrolled inflammatory response. We now know that sepsis represents a biphasic response to infection, and the initial pro-inflammatory response that we have targeted thus far is invariably followed by a prolonged period of immune suppression. Indeed, a patient may oscillate between a pro- and anti-inflammatory state repeatedly. The use of steroids remains controversial, and should probably be reserved for a select subset of patients. The coagulation cascade has a powerful effect on inflammation, and manipulation by means of Activated Protein C has been beneficial. It appears tremendously advantageous to resuscitate the critically ill patient early and aggressively to maintain normal oxidative metabolism. This, coupled with the rigorous maintenance of a physiologically neutral milieu (particularly blood glucose levels) seems to be the most powerful weapon we have to manage the critically ill patient with sepsis.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/9038
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