Der Internist
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Severe sepsis and septic shock have an increasing incidence but an unchanged mortality. It has been demonstrated that the time until the start of supportive therapy affects the progress of multiorgan failure and patient outcome. ⋯ The use of starches for volume resuscitation, low-dose dopamine and hydrocortison as well as an intensive insulin protocol for restoration of euglycemia is not recommended. The German Competence Network Sepsis (SepNet) is currently studying further relevant questions.
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Worldwide, sepsis is one of the leading causes of morbidity and mortality. In Germany about 79,000 (116/100,000) suffer from sepsis, and the incidence of severe sepsis and septic shock is about 75,000 cases per year. Patients are at high risk for irreversible organ failure and a lethal course. ⋯ Early and comprehensive treatment significantly improves outcome. An increased knowledge and awareness about the epidemiology, definitions and therapy of sepsis might contribute to the improved outcome. This review aims to present information on current definitions, epidemiology and the economic burden of sepsis.
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The pathophysiology of sepsis is not completely understood. Bacteria are the main cause of sepsis. Activated receptors of the innate immune system lead to an exaggerated immune response. ⋯ The early phase of sepsis is characterized by a proinflammatory response. In contrast, in the late stage of sepsis an anti-inflammatory milieu is observed that can cause severe immunosuppression. An overview will be given on the recent advances in understanding the interaction of different pathophysiological mechanisms and potential therapeutic interventions in the complex and dynamic syndrome of sepsis.
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Lung transplantation has been established as an appropriate ultimate treatment strategy in end-stage lung disease, when all conventional therapeutic options have been exhausted. A successful transplantation should result in an improved quality of life as well as an increase in life-expectancy for certain diseases (cystic fibrosis, pulmonary fibrosis and pulmonary hypertension). There is still a critical need regarding the number of available donor organs. ⋯ Complications arising after transplantation occur because of general perioperative risks, but also as a result of specific issues such as acute or chronic graft rejection, airway stenoses, infections of the newly immunosuppressed patient as well as a complete spectrum of secondary extra-pulmonary conditions. Comprehensive follow-up care in lung transplantation patients remains a vital issue. Analyses have shown a relevant improvement in long-term outcome, when follow-up care is delivered in cooperation with an established large volume transplant centre.