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Management of severe sepsis: advances, challenges, and current status.

Martin-Loeches I, Levy MM, Artigas A - Drug Des Devel Ther (2015)

Bottom Line: The complexity of treating severe sepsis and septic shock has been elucidated in myriad studies, particularly in the past 10 years.Therapeutic interventions including fluid resuscitation, hemodynamic monitoring, glycemic control, corticosteroids, and antimicrobial therapy and stewardship inform outcomes.Research on biomarkers, use of mesenchymal stem cells, blood purification, immunoglobulins, and antioxidative treatments apropos the immune response may soon yield viable therapies.

View Article: PubMed Central - PubMed

Affiliation: Multidisciplinary Intensive Care Research Organization (MICRO), St James's University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland.

ABSTRACT
The complexity of treating severe sepsis and septic shock has been elucidated in myriad studies, particularly in the past 10 years. The development of clinical guidelines, insight into the effect of bundle elements, and results of clinical trials have brought to light further opportunities and questions in the approach to pharmaceutical interventions for the global challenge to save lives and reduce healthcare costs. Therapeutic interventions including fluid resuscitation, hemodynamic monitoring, glycemic control, corticosteroids, and antimicrobial therapy and stewardship inform outcomes. Research on biomarkers, use of mesenchymal stem cells, blood purification, immunoglobulins, and antioxidative treatments apropos the immune response may soon yield viable therapies.

No MeSH data available.


Related in: MedlinePlus

Steroids for treatment of infections, sepsis, and septic shock – ups and downs.Abbreviations: SSC, Surviving Sepsis Campaign.
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f2-dddt-9-2079: Steroids for treatment of infections, sepsis, and septic shock – ups and downs.Abbreviations: SSC, Surviving Sepsis Campaign.

Mentions: Endogenous glucocorticoids as end-effectors play a role in inhibiting inflammation, but are not always effective in suppressing the cytokine storm driven by a systemic inflammation, even though cortisol levels have been correlated with grades of severity of illness and mortality. With the concept of corticosteroid illness-related corticosteroid insufficiency (CIRCI) and the results of clinical trials showing immune and hemodynamic benefits, corticosteroid therapy has re-emerged as a promising adjunct for the treatment of severe sepsis. From the 1950s to the 1980s, high-dose steroids were used in the management of sepsis. Over the last 40 years, the use of steroids for treatment of infections, sepsis, and septic shock has vacillated (Figure 2).14,48–57 While the use until the late 1990s was based mainly on high doses, the use of low doses (relative adrenal insufficiency dose) has since been the focus of study. On the basis of more recent evidence and published meta-analysis, the benefit of treatment with steroids seems to be limited to patients with vasopressor-dependent septic shock with adequate fluid resuscitation. The adrenocorticotropic hormone stimulation test should not be used to identify those patients with septic shock who should receive glucocorticoids.


Management of severe sepsis: advances, challenges, and current status.

Martin-Loeches I, Levy MM, Artigas A - Drug Des Devel Ther (2015)

Steroids for treatment of infections, sepsis, and septic shock – ups and downs.Abbreviations: SSC, Surviving Sepsis Campaign.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4403600&req=5

f2-dddt-9-2079: Steroids for treatment of infections, sepsis, and septic shock – ups and downs.Abbreviations: SSC, Surviving Sepsis Campaign.
Mentions: Endogenous glucocorticoids as end-effectors play a role in inhibiting inflammation, but are not always effective in suppressing the cytokine storm driven by a systemic inflammation, even though cortisol levels have been correlated with grades of severity of illness and mortality. With the concept of corticosteroid illness-related corticosteroid insufficiency (CIRCI) and the results of clinical trials showing immune and hemodynamic benefits, corticosteroid therapy has re-emerged as a promising adjunct for the treatment of severe sepsis. From the 1950s to the 1980s, high-dose steroids were used in the management of sepsis. Over the last 40 years, the use of steroids for treatment of infections, sepsis, and septic shock has vacillated (Figure 2).14,48–57 While the use until the late 1990s was based mainly on high doses, the use of low doses (relative adrenal insufficiency dose) has since been the focus of study. On the basis of more recent evidence and published meta-analysis, the benefit of treatment with steroids seems to be limited to patients with vasopressor-dependent septic shock with adequate fluid resuscitation. The adrenocorticotropic hormone stimulation test should not be used to identify those patients with septic shock who should receive glucocorticoids.

Bottom Line: The complexity of treating severe sepsis and septic shock has been elucidated in myriad studies, particularly in the past 10 years.Therapeutic interventions including fluid resuscitation, hemodynamic monitoring, glycemic control, corticosteroids, and antimicrobial therapy and stewardship inform outcomes.Research on biomarkers, use of mesenchymal stem cells, blood purification, immunoglobulins, and antioxidative treatments apropos the immune response may soon yield viable therapies.

View Article: PubMed Central - PubMed

Affiliation: Multidisciplinary Intensive Care Research Organization (MICRO), St James's University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland.

ABSTRACT
The complexity of treating severe sepsis and septic shock has been elucidated in myriad studies, particularly in the past 10 years. The development of clinical guidelines, insight into the effect of bundle elements, and results of clinical trials have brought to light further opportunities and questions in the approach to pharmaceutical interventions for the global challenge to save lives and reduce healthcare costs. Therapeutic interventions including fluid resuscitation, hemodynamic monitoring, glycemic control, corticosteroids, and antimicrobial therapy and stewardship inform outcomes. Research on biomarkers, use of mesenchymal stem cells, blood purification, immunoglobulins, and antioxidative treatments apropos the immune response may soon yield viable therapies.

No MeSH data available.


Related in: MedlinePlus