Medline ® Abstract for Reference 26
of 'Sepsis syndromes in adults: Epidemiology, definitions, clinical presentation, diagnosis, and prognosis'
Annane D, Bellissant E, Cavaillon JM
Septic shock, the most severe complication of sepsis, is a deadly disease. In recent years, exciting advances have been made in the understanding of its pathophysiology and treatment. Pathogens, via their microbial-associated molecular patterns, trigger sequential intracellular events in immune cells, epithelium, endothelium, and the neuroendocrine system. Proinflammatory mediators that contribute to eradication of invading microorganisms are produced, and anti-inflammatory mediators control this response. The inflammatory response leads to damage to host tissue, and the anti-inflammatory response causes leucocyte reprogramming and changes in immune status. The time-window for interventions is short, and treatment must promptly control the source of infection and restore haemodynamic homoeostasis. Further research is needed to establish which fluids and vasopressors are best. Some patients with septic shock might benefit from drugs such as corticosteroids or activated protein C. Other therapeutic strategies are under investigation, including those that target late proinflammatory mediators, endothelium, or the neuroendocrine system.
Service de Réanimation, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Facultéde Médecine Paris Ile de France Ouest, Universitéde Versailles Saint Quentin en Yvelines, Garches, France. firstname.lastname@example.org