Nihon rinsho. Japanese journal of clinical medicine
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We outline the epidemiology of the systemic inflammatory response syndrome (SIRS), sepsis and severe sepsis among intensive care unit (ICU) patients in Japan. One survey conducted in the ICU of a university hospital suggested that the prevalence of SIRS reached 84% among all ICU patients, and that about 8% of patients with SIRS progressed to severe sepsis. ⋯ Moreover, a graded severity was noted from SIRS to sepsis and severe sepsis, with total in-hospital mortality of 6%, 20% and 63%, respectively. Thus, every effort should be made to decrease the risk of sepsis in ICU patients.
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This article will review for bedside clinicians how to manage septic ALI. ARDS and shock to use the principles of EBM to evaluate the various therapeutic approaches for them. Low tidal volume ventilation (6 mg/dl/kg) is recommended for ALI. ⋯ Aggressive infusion of crystalloid and colloid is recommended for septic shock, but blood transfusion and bicarbonate administration are not recommended. Vasopressors are recommended for septic shock: preference for norepinephrine and cautious use of vasopressin. Stress-dose of steroid and activated protein C for severe sepsis are useful if shock don't recover by aggressive fluid infusion and vasopressors' administration.
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Bacterial factors stimulate the release of tissue factor as well as proinflammatory and antiinflammatory cytokines. TNF augments inflammation, TNF and IFN-gamma induce coagulation, and IL-1beta induces coagulation and fibrinolysis. IL-8 augments synergistic inflammation and coagulation. ⋯ Patients who died of SIRS/sepsis have been complicated with hypercoagulopathy and impaired fibrinolysis correlated with increased IL-10 production. Inhibition of IL-10 production or administration of fiblynolitic agents may be useful. Recently, activated protein C (APC) which has antiinflammatory effect has been paid attention in the treatment of SIRS/sepsis.