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Choc septique

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Infectiologie en réanimation

Part of the book series: Références en réanimation. Collection de la SRLF ((SRLF))

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Résumé

Le terme sepsis couvre un spectre large de présentations cliniques hétérogènes et de pronostic variable mais dotées de mécanismes physiopathologiques communs. Les critères de Bone, établis en 1992 [1] et réactualisés en 2003 [2], ont permis d’établir une classifi cation clinique simple et opérationnelle composée de trois entités nosologiques de sévérité croissante en fonction des défaillances d’organes : sepsis, sepsis sévère et choc septique (tableau I). L’incidence globale du sepsis est en augmentation en raison de la prévalence croissante de populations vulnérables, et représente la première cause de décès en réanimation. Néanmoins, le pronostic du sepsis sévère et du choc septique s’est notablement amélioré au cours de la dernière décade. La diffusion large de recommandations internationales prônant un traitement précoce de l’infection responsable et une prise en charge agressive des défaillances d’organes a certainement contribué à cette tendance. À cette prise en charge classique s’ajoutent des mesures thérapeutiques adjuvantes controversées, comme la corticothérapie ou le contrôle glycémique. Malgré une intense activité de recherche fondamentale qui s’est fortement accélérée dans les années 1990 par la découverte des récepteurs Toll, les importantes avancées réalisées dans la compréhension des mécanismes immunopathologiques du sepsis n’ont pour le moment pas abouti à des interventions thérapeutiques efficaces. Dans ce chapitre nous aborderons les progrès réalisés dans la compréhension de la physiopathologie du choc septique ainsi que les modalités thérapeutiques actuelles.

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  1. Service de réanimation médicale, hôpital Cochin, AP-HP, Paris, Université Paris Descartes, Sorbonne Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France

    F. Daviaud & F. Pène

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Daviaud, F., Pène, F. (2013). Choc septique. In: Infectiologie en réanimation. Références en réanimation. Collection de la SRLF. Springer, Paris. https://doi.org/10.1007/978-2-8178-0389-0_16

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