NEW DEVELOPMENTS IN THE PATHOGENESIS AND TREATMENT OF SEPSIS

Abstract

Background. Severe sepsis and septic shock are the most important causes of death in patients in intensive care units. In the last decades the incidence of sepsis increased and the case-fatality rate of septic shock did not decreased significantly despite improved intensive care medicine. Clinical presentations of severe sepsis and septic shock are predominantly a result of dysregulation of the immune system caused by parts of the bacterial cell wall, endotoxins and exotoxins. Inflammatory cascade and cytokines plays an important role in the pathogenesis of sepsis. Conclusions. Early and appropriate antimicrobial treatment as well as surgical removal of an septic focus improve the survival of patients with sepsis. In the past, various immunomodulatory therapies (antiendotoxins, antimediator interventions and immunostimulation therapy) did not decreased the mortality of patients with sepsis. In the last years, however, some interventions in selected patients with severe sepsis and septic shock have shown significantly improved survival. These interventions include treatment with activated protein C, early goal-directed therapy, intensive treatment with insulin, low-dose corticosteroid treatment and use of low tidal volumes in patients with acute lung injury or acute respiratory distress syndrome. In this article new developments in pathogenesis and therapy of sepsis are reviewed.