Quelles perspectives thérapeutiques dans le syndrome septique ?

Abstract

Objective. – To evaluate recent data provided on new treatments of patients with septic shock. Data extraction. – A Medline search was performed to identify pertinent literature on the pathophysiology of septic shock and treatment strategies from 1990 to 2003. Keywords were “septic shock”, “sepsis”, “inflammation” and “management”. Data synthesis. – Advances were performed in our current understanding of pathophysiology of sepsis. The loss of homeostatic balance among the systemic inflammatory response and the disturbance of coagulation with generalized coagulopathy lead to organ failures and death. The administration of activated protein C (drotrecogin alfa) reducing this coagulopathy can decrease the mortality of septic shock patients. The modulation of inflammation did not make it possible to improve survival of septic shock patients until now. The efficacy of low doses of steroid has been recently shown in septic shock patients. In addition, new data highlighted the interest of an early goal therapy in patients with sepsis who are admitted to emergency. Conclusion. – The improvement of survival in septic syndrome patients is a difficult challenge. The uses of different new therapeutic options like protein C reactive, steroids, or early goal therapy in association should make it possible to reduce the mortality in septic patients.