Swiss medical weekly
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Recent developments in the pathophysiology and treatment of sepsis have clearly shown the confusion produced by the imprecise terminology used to define the various facets of the sepsis process. The criteria required to diagnose bacteremia, sepsis, sepsis syndrome or septic shock vary from one author to the other. This inaccuracy accounts for the inability to compare the results of therapeutic investigation from different groups. The aim of this article is to point out the necessity of standardized terminology and to propose definitions which might be appropriate.
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Septic shock is an acute impairment of tissue perfusion, characterized by hypotension, low systemic vascular resistance and increased blood levels of lactate. Myocardial dysfunction is common despite hyperdynamic circulation, and may limit the patient's ability to respond to increased tissue oxygen demand. ⋯ The disproportionately high splanchnic oxygen demand in sepsis makes the splanchnic region susceptible to tissue hypoxia, which may contribute to the development of multiple organ failure in septic shock. Since the changes in regional oxygen transport do not necessarily parallel changes in systemic oxygen transport, the effects of vasoactive drugs on regional blood flow in sepsis should be studied in more detail.
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To reduce the very high mortality rate due to septic shock, a new clinical entity has been defined: sepsis syndrome. The aggressive treatment of any sepsis syndrome should prevent the evolution towards a state of shock and thus reduce the risk of a fatal outcome. ⋯ Several pharmacological or immunological interventions--antagonists directed at mediators and multiple cytokines involved in the pathogenesis and perpetuation of sepsis syndrome and septic shock--have been successful experimentally. However, new therapies, such as those using monoclonal antibodies against endotoxins of TNF, cannot yet be considered established.