Russell JA: Management of sepsis

University of British Columbia, Critical Care Medicine, St. Paul's Hospital, Vancouver, BC, Canada.
New England Journal of Medicine (Impact Factor: 55.87). 11/2006; 355(16):1699-713. DOI: 10.1056/NEJMra043632
Source: PubMed


Optimal management of sepsis requires early, goal-directed therapy; lung-protective ventilation; antibiotics; and possibly activated protein C. 56 The use of corticosteroids, vasopressin, and intensive insulin therapy requires further study. Later in the course of sepsis, appropriate management necessitates organ support and prevention of nosocomial infection. Studies focused on novel targets, mechanisms of action, and combination therapy may improve current treatment.

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    • "This occurs in conjunction with increases in the expression of inducible nitric oxide (NO) synthase, increasing production of NO resulting in coagulopathy, endothelial dysfunction, vascular instability, and eventually to apoptosis (i.e. programmed cell death) and multi-organ failure [8]. A marker of sepsis has been defined as a measure that predicts the presence or severity of the disease. "
    01/2015; 3(1). DOI:10.11648/j.ajim.20150301.12
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    • "Sepsis is the generalized inflammatory response elicited by an infectious process [1]. More than 75,000 patients die of septic shock every year in the USA, making this syndrome the leading cause of death in noncoronary intensive care units [2] [3]. The respiratory system is the most frequently affected organ system, and lung dysfunction such as acute lung injury (ALI) or adult respiratory distress syndrome (ARDS) is the first step in the development of multiple organ failure [4e6]. "
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    ABSTRACT: Toona sinensis (TS) leaves are used as a vegetable and in traditional Chinese medicine. However, in vivo experiments regarding the anti-inflammatory function of TS leaves have not previously been conducted. The aim of this study was to investigate the potential role of TS leaf extract (TSL) in the prevention of sepsis-induced lung injury in vivo and on macrophage activation in vitro. The results showed that oral gavage pretreatment with TSL in rats for 30 days improved the survival of cecal ligation and puncture-induced sepsis, potentially by attenuating sepsis-induced histological lung damage rather than inflammatory cell infiltration. Furthermore, we demonstrated that pretreatment with TSL attenuated the lipopolysaccharide (LPS)-induced expression of inducible nitric oxide synthase, thereby inhibiting nitric oxide production and release in murine macrophage-like RAW 264.7 cells. Interestingly, TSL did not affect the LPS-induced release of other cytokines (e.g., tumor necrosis factor α and interleukin 1β) but increased LPS-induced heme-oxygenase-1 expression. In conclusion, the study provides preliminary data for TSL on cecal ligation and puncture-induced sepsis. The beneficial impact of TSL needs extensive study to get solid evidence.
    The Kaohsiung journal of medical sciences 06/2014; 30(6). DOI:10.1016/j.kjms.2014.02.013 · 0.80 Impact Factor
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    • "Despite recent advances in the management, such as the evolution of support therapy and the use of new anti-infective agents, sepsis continues to pose a challenge in critical care. With the increasing understanding of the pathophysiology of sepsis, the attention has focused on new therapeutic approaches targeting dysregulated host response rather than the microorganism that elicited it [20]. In addition to the administration of antibiotics and the eradication of septic foci when indicated , several adjuvant therapies, aimed at modulating the immune system, have been considered. "
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    ABSTRACT: Sepsis syndrome is characterized by a systemic inflammatory response to infection potentially leading to acute organ failure and rapid decline to death. Polyclonal intravenous immune globulin, a blood product derived from human donor blood, in addition to antiinfective activities, also exerts a broad antiinflammatory and immunomodulating effect. Intravenous immunoglobulin (IVIg) has been proposed as adjuvant therapy for sepsis even though the clinical studies demonstrating their efficacy and safety are relatively small. Several systematic reviews and meta-analyses of intravenous immunoglobulin treatment in sepsis have been performed. As a result of heterogeneity across studies and inconsistencies in results, the majority have concluded that more evidence, coming from large, well-conducted randomized controlled trials (RCTs), is required. Moreover the appropriate timing of administration and the identification of specific clinical settings represent a key factor to maximizing their beneficial effect. The authors, in this revision, review the basic mechanisms of action of IVIg, the rationale for their use, and their clinical applications.
    European Journal of Internal Medicine 05/2014; 25(6). DOI:10.1016/j.ejim.2014.05.002 · 2.89 Impact Factor
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