New evaluation therapies for sepsis

This article presents an analysis of the literature of the last 2 years on the treatment of sepsis and septic shock. It appears that most of the antimediator therapies applied in phase II or III clinical trials yielded disappointing results. But, many other therapeutic approaches are proposed or are ongoing, and many papers report critical analysis of the reasons for the lack of success of past clinical trials.

Management of the septic patient in the operating room

Sepsis, severe sepsis, and septic shock represent the spectrum of physiological response to a variety of infecting pathogens. Multiple-organ dysfunction may result from widespread activation of inflammatory and antiinflammatory mechanisms. Intensive multiorgan support, effective antibiotic therapy, and eradication of the inciting source remain the cornerstones in the care of septic patients. Perioperative planning and management need to ensure the continuation of such care in addition to providing for the requirements of the given surgical procedure.

Current therapy for sepsis

The treatment of severe sepsis and septic shock remains a challenge as we approach the next millennium. Although more attention is being given to guidelines and care pathways for sepsis, these are unfortunately based primarily on consensus opinion. Additional research into supportive interventions in this potentially devastating disease is needed. Priorities in the management of sepsis include rapid reversal of hypotension and hypoperfusion, followed by empiric antibiotic therapy and definitive localization and treatment of infection nidus. A wide variety of adrenergic agents may be useful in sepsis. Initial therapy for hypoperfusion, however, should be targeted toward establishing adequate intravascular volume and left ventricular preload. Adjunctive therapy to prevent complications during the intensive care unit stay is important.