Medical science monitor : international medical journal of experimental and clinical research
-
Sepsis and septic shock account for substantial morbidity and mortality in the intensive care units. NF-kappaB activation, and elevated concentrations of macrophage migration inhibitory factor (MIF), tumor necrosis factor-a (TNF-alpha), interleukin-1 (IL-1), IL-6, free radicals, inducible nitric oxide (iNO), and stress hyperglycemia are some of the factors that induce systemic inflammatory response and myocardial depression seen in sepsis. Conversely, adenosine, activated protein C, oxidized phospholipids, w-3 fatty acids, and insulin have beneficial effects in sepsis and septic shock. ⋯ In addition, insulin corrects stress hyperglycemia and improves myocardial function. Thus insulin, adenosine, activated protein C, oxidized phospholipids, and w-fatty acids show anti-inflammatory actions and explain why and how they are useful in sepsis and septic shock and possibly, other inflammatory conditions. Hence, their combined use may be of significant benefit in sepsis and septic shock.
-
Severe sepsis is a disease associated with high mortality rates, which may be related to late diagnosis and institution of treatment, as well as unsatisfactory effectiveness of therapies used so far. Frequent monitoring of the patient's clinical condition and laboratory results for early signs of sepsis and use of recombinant activated protein C can improve significantly the outcome of treatment. ⋯ In both presented cases, the therapy with drotrecogin alfa (activated) was used due to lack of satisfactory response to initial standard treatment. Both cases indicate that the preparation is effective and safe.