Swiss medical weekly
-
To reduce the very high mortality rate due to septic shock, a new clinical entity has been defined: sepsis syndrome. The aggressive treatment of any sepsis syndrome should prevent the evolution towards a state of shock and thus reduce the risk of a fatal outcome. ⋯ Several pharmacological or immunological interventions--antagonists directed at mediators and multiple cytokines involved in the pathogenesis and perpetuation of sepsis syndrome and septic shock--have been successful experimentally. However, new therapies, such as those using monoclonal antibodies against endotoxins of TNF, cannot yet be considered established.
-
Septic shock is an acute impairment of tissue perfusion, characterized by hypotension, low systemic vascular resistance and increased blood levels of lactate. Myocardial dysfunction is common despite hyperdynamic circulation, and may limit the patient's ability to respond to increased tissue oxygen demand. ⋯ The disproportionately high splanchnic oxygen demand in sepsis makes the splanchnic region susceptible to tissue hypoxia, which may contribute to the development of multiple organ failure in septic shock. Since the changes in regional oxygen transport do not necessarily parallel changes in systemic oxygen transport, the effects of vasoactive drugs on regional blood flow in sepsis should be studied in more detail.