Year in review 2013: Critical Care--sepsis.

Etienne De Montmollin,Djillali Annane

doi:10.1186/s13054-014-0578-x

Abstract

This review presents key publications from the research field of sepsis published in Critical Care and other relevant journals during 2013. The results of these experimental studies and clinical trials are discussed in the context of current scientific and clinical background. The discussion highlights and summarises articles on four main topics: sepsis pathogenesis, diagnostic and prognostic biomarkers, potential new therapies, and epidemiologic and outcome studies.

Highlights

Despite intense experimental and clinical research activity over the past decades, sepsis still remains an elusive syndrome
Actual understanding has led to international recommendations on diagnosis and treatment [1], but management of severe sepsis and septic shock in the ICU still represents a major challenge for clinicians in 2014, with high mortality rates
This study suggests distinct harmful roles of Highmobility group box 1 (HMGB1) and receptor for advanced glycation end-products (RAGE), but not of toll-like receptor 4 (TLR4), in the development of lung injury during the early phase of severe pneumonia caused by S. aureus

Summary

Introduction

Despite intense experimental and clinical research activity over the past decades, sepsis still remains an elusive syndrome. Day 1 kallistatin plasma levels were lower in patients who had septic shock and developed ARDS, and the sensitivity and specificity for predicting death for a cutoff value of 6.5 μg/ml were, respectively, 81% and 54% These findings indicate that kallistatin may be protective against severe community-acquired pneumonia, which implies possible therapeutic benefits of kallistatin in these patients. Human studies Rimmelé and colleagues showed that the use of haemoadsorption devices on the blood of septic shock patients enabled the capture of monocytes and neutrophils, but not lymphocytes, and led to a local release of IL-8 and changes in T-cell function [45] This more systematic approach with tight immune monitoring is important to better understand the action of haemoadsorption devices in sepsis. These epidemiological findings should lead to further investigations of the relation between immune response to sepsis and sex steroid hormones

Conclusion

Findings

13. Sharawy N