Sepsis: Current state of play

The treatment of septic shock has, until very recently, relied on eradication of the causative infection using antibiotics and surgical removal where appropriate, and individual organ support including renal dialysis and mechanical ventilation. These aspects of management are still vitally important, but years of intense research have helped elucidate many of the mechanisms underlying the sepsis response, and new sepsis-specific therapies are being developed. An important advance in our understanding of the sepsis respone has been the recognition of the link between the processes of inflammation and coagulation, which led to the development and licensing of drotrecogin alfa (activated) for the treatment of patients with severe sepsis. Other progress in the treatment of sepsis includes recent studies showing From the Department of Intensive Care, Erasme Hospital,Free University of Brussels, Belgium (Drs. Jean-Louis Vincent, Marc Vannuffelen and Ahmed Zakariah). Address requests for reprints to: Jean-Louis Vincent,M.D., Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium that the administration of moderate doses of hydrocortisone to patients presenting with an abnormal adrenal response to an ACTH test improves survival from septic shock. The importance of early goal-directed resuscitation in patients with severe sepsis or septic shock has also been highlighted recently as a key factor in achieving the best patient outcomes. Definitions are also being revised to facilitate study design and comparison, and the development of a sepsis grading system, similar to those used in patients with cancer, is currently being worked on to help characterize patients and monitor response to therapy. Following the positive results from recent trials, the future is certainly looking brighter for the patient with severe sepsis and the results of ongoing research are eagerly awaited.