Improvement in Hemodynamics by Activated Protein C in Septic Shock
Recombinant human activated protein C (rhAPC) has been approved by the US Food and Drug Administration (FDA) for treating patients with sepsis or septic shock with an APACHE II score of more than 25 and by the European Agency for the Evaluation of Medicinal Products for multiple organ failure (MOF) related to sepsis. Furthermore, guidelines of the Surviving Sepsis Campaign recommend rhAPC as a standard-of-care for patients with severe sepsis and septic shock . These approvals and recommendations were mainly supported by the results of the worldwide Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study , in which rhAPC was demonstrated to increase the survival rate of patients with the most severe forms of septic shock. This seminal study was focused on the overall mortality as the main criterion of judgement. Nevertheless in the following years, experimental and clinical studies suggested that rhAPC induces a specific improvement in the cardiovascular failure during septic shock. In this chapter, we will review these studies and the underlying mechanisms that are supposed to explain the effects of APC.
KeywordsSeptic Shock Severe Sepsis Mean Arterial Pressure Septic Shock Patient Survive Sepsis Campaign
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