Advertisement

Sepsis and the role of the human host

  • M. E. Hartman
  • D. C. Angus
Conference paper

Abstract

This is an exciting time in sepsis research. Not only do we understand more about the epidemiology and pathophysiology of sepsis than ever before, but due to recent successful therapeutic trials [1–3], we now have sepsis-specific dmgs that improve survival. However, even with these developments, there remain a significant number of challenges. The more we understand about the complexity of sepsis, the more we are required to reflect this complexity in our trials if they are to remain applicable to the average intensive care unit (ICU) patient. Unfortunately, determining all the relevant variables and following them for a sufficient period of time is both difficult and expensive. While these issues are not necessarily unique to intensive care, they play a particularly prominent role in sepsis research because of the nature of sepsis and its patient population.

Keywords

Severe Sepsis Systemic Inflammatory Response Syndrome Multiple Organ Dysfunction Score Acute Organ Dysfunction Sepsis Trial 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bernard GR, Vincent JL, Laterre PF, et al (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699–709PubMedCrossRefGoogle Scholar
  2. 2.
    Rivers E, Nguyen B, Havstad S, et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377PubMedCrossRefGoogle Scholar
  3. 3.
    Annane D, Sebille V, Charpentier C, et al (2002) Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 288:862–871PubMedCrossRefGoogle Scholar
  4. 4.
    Bone RC, Balk RA, Cerra FB, et al (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicme. Chest 101:1644–1655PubMedCrossRefGoogle Scholar
  5. 5.
    Pittet D, Thievent B, Wenzel RP, et al (1996) Bedside prediction of mortahty from bacteremic sepsis. A dynamic analysis of ICU patients. Am J Respir Crit Care Med 153:684–693PubMedCrossRefGoogle Scholar
  6. 6.
    Reinhart K, Wiegand-Lohnert C, Grimminger F, et al (1996) Assessment of the safety and efficacy of the monoclonal anti-tumor necrosis factor antibody-fragment, MAK195F, in patients with sepsis and septic shock: a multicenter, randomized, placebo-controlled, dose-ranging study. Crit Care Med 24:733–742PubMedCrossRefGoogle Scholar
  7. 7.
    Rangel-Frausto MS, Pittet D, Costigan M, et al (1995) The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 273:117–123PubMedCrossRefGoogle Scholar
  8. 8.
    Cohen J, Guyatt G, Bernard GR, et al (2001) New strategies for clinical trials in patients with sepsis and septic shock. Crit Care Med 29:880–886PubMedCrossRefGoogle Scholar
  9. 9.
    Vincent JL (1997) Dear SIRS, I’m sorry to say that I don’t like you. Crit Care Med 25:372–374PubMedCrossRefGoogle Scholar
  10. 10.
    Angus DC, Linde-Zwirble WT, Lidicker J, et al (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310PubMedCrossRefGoogle Scholar
  11. 11.
    Sands KE, Bates DW, Lanken PN, et al (1997) Epidemiology of sepsis syndrome in 8 academic medical centers. Academic Medical Center Consortium Sepsis Project Working Group. JAMA 278:234–240PubMedCrossRefGoogle Scholar
  12. 12.
    Brun-Buisson C, Doyon F, Carlet J, et al (1995) Incidence, risk factors, and outcome of severe sepsis and septic shock in adults: a multicenter prospective smdy in intensive care units. JAMA 274:968–974PubMedCrossRefGoogle Scholar
  13. 13.
    Knaus WA, Wagner DP, Draper EA, et al (1991) The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100:1619–1636PubMedCrossRefGoogle Scholar
  14. 14.
    Vincent JL, Moreno R, Takala J, et al (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710PubMedCrossRefGoogle Scholar
  15. 15.
    MarshallilC Cook DJ, Christou NV, et al (1995) Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 23:1638–1652CrossRefGoogle Scholar
  16. 16.
    Clermont G, Angus DC, Linde-Zwirble WT, et al (2002) Does acute organ dysfunction predict patient-centered outcomes? Chest 121:1963–1971PubMedCrossRefGoogle Scholar
  17. 17.
    Quartm AA, Schein RM, Kett DH, Peduzzi PN, for the Department of Veterans Affairs Systemic Sepsis Cooperative Studies Group (1997) Magnitude and duration of the effect of sepsis on survival. JAMA 277:1058–1063CrossRefGoogle Scholar
  18. 18.
    Perl TM, Dvorak L, Hwang T, Wenzel RP (1995) Long-term survival and function after suspected gram-negative sepsis. JAMA 274:338–345PubMedCrossRefGoogle Scholar
  19. 19.
    Kaplan V, Clermont G, Griffin MF, et al (2002) Pneumonia — still the old man’s friend? Arch Intem Med (in press)Google Scholar
  20. 20.
    Packer M (1992) Effect of oral milrinone on mortahty in severe chronic heart-failure. Herz Kreislauf 24:276Google Scholar
  21. 21.
    Hebert PC, Wells G, Blajchman MA, et al (1999) A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 340:409–417PubMedCrossRefGoogle Scholar
  22. 22.
    Gariand JS, Alex CP, Pauly TH, et al (1999) A three-day course of dexamethasone therapy to prevent chronic lung disease in ventilated neonates: a randomized trial. Pediatrics 104:91–99CrossRefGoogle Scholar
  23. 23.
    Taylor HG, Klein N, Hack M (2000) School-age consequences of birth weight less than 750 g: a review and update (review). Dev Neuropsychol 17:289–321PubMedCrossRefGoogle Scholar
  24. 24.
    O’Shea TM, Kothadia JM, Klinepeter KL, et al (1999) Randomized placebo-controlled trial of a 42-day tapering course of dexamethasone to reduce the duration of ventilator dependency in very low birth weight infants: outcome of study participants at 1-year adjusted age. Pediatrics 104:15–21PubMedCrossRefGoogle Scholar
  25. 25.
    Montuclard L, Garrouste-Orgeas M, Timsit JF, et al (2000) Outcome, functional autonomy, and quality of life of elderly patients with a long-term intensive care unit stay. Crit Care Med 28:3389–3395PubMedCrossRefGoogle Scholar
  26. 26.
    Angus DC, Cariet J, on behalf of the 2002 Bmssels Roundtable Participants (2002) Surviving intensive care — A report from the 2002 Bmssels Roundtable. Intensive Care Med (in press)Google Scholar

Copyright information

© Springer-Verlag Italia 2003

Authors and Affiliations

  • M. E. Hartman
  • D. C. Angus

There are no affiliations available

Personalised recommendations