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| The therapy of sepsis rests on ]s, surgical drainage of infected fluid collections, fluid replacement and appropriate support for organ dysfunction. This may include ] in ] failure, ] in ] dysfunction, transfusion of ], ] and coagulation factors to stabilize blood ], and drug and fluid therapy for circulatory failure. Ensuring adequate nutrition, if necessary by ], is important during prolonged illness. | The therapy of sepsis rests on ]s, surgical drainage of infected fluid collections, fluid replacement and appropriate support for organ dysfunction. This may include ] in ] failure, ] in ] dysfunction, transfusion of ], ] and coagulation factors to stabilize blood ], and drug and fluid therapy for circulatory failure. Ensuring adequate nutrition, if necessary by ], is important during prolonged illness. | ||
| Most therapies aimed at the inflammatory process itself have failed to improve outcome. However, ], one of the ]s |
Most therapies aimed at the inflammatory process itself have failed to improve outcome. However, ] (activated ], one of the ]s) has been shown to decrease mortality from about 31% to about 25% in severe sepsis (Bernard et al. ''NEJM'' 2001). Low dose ] treatment has shown promise for ] patients with relative ]. | ||
| ==Related conditions== | ==Related conditions== | ||
Revision as of 23:12, 23 August 2004
Sepsis is a serious medical condition caused by a severe systemic infection leading to a systemic inflammatory response. The more critical subsets of sepsis include severe sepsis (sepsis with organ dysfunction) and septic shock (sepsis with refractory arterial hypotension).
The systemic inflammatory response syndrome leads to widespread activation of inflammation and coagulation pathways. This may progress to dysfunction of the circulatory system and, even under optimal treatment, multiple organ dysfunction syndrome and eventually death.
Sepsis is more common and also more dangerous in elderly, immunocompromised, and critically ill patients. It occurs in 2% of all hospitalizations and accounts for as much as 25% of intensive care unit (ICU) bed utilization. It is a major cause of death in intensive care units worldwide, with mortality rates that range from 20% for sepsis to 40% for severe sepsis to >60% for septic shock. In the United States, sepsis is the leading cause of death in non-coronary ICU patients, and the tenth most common cause of death overall according to 2000 data from the Centers for Disease Control. (See Martin, et al. NEJM 2003).
Treatment
The therapy of sepsis rests on antibiotics, surgical drainage of infected fluid collections, fluid replacement and appropriate support for organ dysfunction. This may include hemodialysis in kidney failure, mechanical ventilation in pulmonary dysfunction, transfusion of blood plasma, platelets and coagulation factors to stabilize blood coagulation, and drug and fluid therapy for circulatory failure. Ensuring adequate nutrition, if necessary by parenteral nutrition, is important during prolonged illness.
Most therapies aimed at the inflammatory process itself have failed to improve outcome. However, drotrecogin (activated protein C, one of the coagulation factors) has been shown to decrease mortality from about 31% to about 25% in severe sepsis (Bernard et al. NEJM 2001). Low dose cortisol treatment has shown promise for septic shock patients with relative adrenal insufficiency.
Related conditions
- Infection is an inflammatory response to a microorganism, or the invasion of normally sterile host tissues by the organism.
- Bacteraemia is the presence of bacteria in the blood. Bacteraemia can occur in sepsis and other serious diseases such as infective endocarditis, but it may also be a harmless and transient condition.
- septic shock
- multiple organ dysfunction syndrome
References
- Bernard, et al. NEJM 2001; 344:699-709.
- Martin, et al. NEJM 2003; 346:1546-64.