Sepsis: pathophysiology and clinical management

  title={Sepsis: pathophysiology and clinical management},
  author={Jeffrey E Gotts and Michael A. Matthay},
  journal={British Medical Journal},
Sepsis, severe sepsis, and septic shock represent increasingly severe systemic inflammatory responses to infection. Sepsis is common in the aging population, and it disproportionately affects patients with cancer and underlying immunosuppression. In its most severe form, sepsis causes multiple organ dysfunction that can produce a state of chronic critical illness characterized by severe immune dysfunction and catabolism. Much has been learnt about the pathogenesis of sepsis at the molecular… 

Diagnosis and management of sepsis.

The features of sepsis that are of most relevance to acute general physicians are considered, which include endothelial dysfunction, coagulation abnormalities, alterations in cell function and dysregulated cardiovascular responses.

Sepsis and Septic Shock

The prevalence of pediatric septic shock is on the rise and brings with it the consequences of long-term morbidity and also death, with no current standard definition for severe sepsis for the pregnant or peripartum woman.

Evaluation of Serum Selenium Levels in Sepsis Patients Hospitalized in Tabriz

Investigating the serum level of Se in patients with sepsis in hospitals affiliated to Tabriz University of Medical Sciences can pave the way for various interventions to timely identify this complication and treatment methods to improve the condition of these patients while reducing hospital deaths.

Sepsis: Staging and Potential Future Therapies

This book provides an overview about the state of the art of sepsis diagnostics and potential future therapies and introduces an important modulator of the immune response—the endogenous cannabinoid system and elucidates its role in organ dysfunction in sepsi.

Stem Cell–based Therapies for Sepsis

This review examines the rationale for stem cells in sepsis, focusing on mesenchymal stem/stromal cells, which currently demonstrate the greatest therapeutic promise, and examines the preclinical evidence base and potential mechanisms of action of these cells that are important in the setting of sepsi.

Gases in Sepsis: Novel Mediators and Therapeutic Targets

The state-of-the-art knowledge on the pathophysiology of sepsis; the metabolism and physiological function of NO, CO and H2S; the crosstalk among these gaseous mediators; and their crucial effects on the development and progression of Sepsis are summarized.

Sepsis to Septic Shock

Outcomes are improved by early identification of sepsis and the immediate initiation of evidence-based therapy following sepsi recognition, including aggressive fluid resuscitation and antimicrobial therapy, according to the World Health Organization.

Host response and outcome of sepsis in the critically ill

Evidence is provided that a disturbed host response towards a more hyperinflammatory phenotype renders sepsis patients more vulnerable to develop a secondary infection while on the intensive care unit, and the research presented in this thesis provides evidence.

Sepsis and septic shock: current approaches to management

A substantial reduction in the burden of sepsis‐related disease requires action across the entire healthcare system, with much of the valuable data coming from National Health and Medical Research Council‐funded trials run from Australia.



Sepsis-associated Acute Kidney Injury

Most of the topics and the hypothesis regarding SA-AKI in this review are concluded and the understanding in immune response pattern of sepsis and sepsi pathophysiology is necessary for “sepsis mechanistic approach”.

The role of the endothelium in severe sepsis and multiple organ dysfunction syndrome.

The goals of this article are to provide an overview of sepsis and its complications, discuss the role of the endothelium in orchestrating the host response insepsis, and emphasize the potential value of the artery as a target for sepsi therapy.

Cytokines in Sepsis: Potent Immunoregulators and Potential Therapeutic Targets—An Updated View

This review addresses the current knowledge of the actions of pro- and anti-inflammatory cytokines in sepsis pathophysiology as well as how these cytokines and other important immunomodulating agents may be therapeutically targeted to improve the clinical outcome of sepsi.

Severe sepsis and septic shock: the role of gram-negative bacteremia.

  • R. Munford
  • Medicine, Biology
    Annual review of pathology
  • 2006
This review considers two alternatives for the pathogenesis of severe sepsis and septic shock: in the first, circulating Gram-negative bacteria induce toxic reactions directly within the vasculature; in the second, the major inflammatory stimulus occurs in local extravascular sites of infection and circulating bacteria contribute little to inducing toxic responses.

Systemic steroids in severe sepsis and septic shock.

  • G. PatelR. Balk
  • Medicine
    American journal of respiratory and critical care medicine
  • 2012
This concise evidence-based review highlights the strengths and weaknesses of the current data to inform the practicing clinician as to which patients are likely to derive significant benefit from corticosteroid treatment, while waiting for more definitive guidance from future multicenter, prospective, randomized, controlled trials designed to better answer these important therapeutic questions.

Immunosuppression in patients who die of sepsis and multiple organ failure.

Patients who die in the ICU following sepsis compared with patients who die of nonsepsis etiologies have biochemical, flow cytometric, and immunohistochemical findings consistent with immunosuppression, and targeted immune-enhancing therapy may be a valid approach in selected patients with sepsi.

Pathogenesis and treatment of disseminated intravascular coagulation in the septic patient.

  • M. Levi
  • Medicine, Biology
    Journal of critical care
  • 2001
Recent clinical trials have supported the use of antithrombin and activated protein C supplementation in DIC associated with severe sepsis, and future efforts may be directed at combining 2 or more agents to achieve prompt and successful reversal of DIC.

Impact of sepsis on CD4 T cell immunity

Understanding of how sepsis affects CD4 T cells through their numerical loss and recovery, as well as function, is important in the development of future treatments designed to restore CD 4 T cells to their presepsis state.

High-volume haemofiltration for sepsis.

There is insufficient evidence to recommend the use of HVHF in critically ill patients with severe sepsis and or septic shock except as interventions being investigated in the setting of a randomized clinical trial.

Strategies to improve drug development for sepsis

Investigators will need to identify more suitable therapeutic targets, improve their approaches for selecting candidate compounds for clinical development and adopt better designs for clinical trials to improve upon this dismal record of results.