[Latest results of intensive care of sepsis, septic shock and multiple organ injuries].
Author is first discussing sepsis and its new categories (SIRS, MODS), its pathogenesis and symptoms. One axis of the events is the release of inflammatory and anti-inflammatory cytokines from the monocytes and macrophages, due to the precipitating injury. The other one is the activation of the polymorphonuclear leucocytes and the endothelial cells and their interaction. The basically non infectious SIRS is often maintained and worsened to MODS by the "translocation" of bacteria and endotoxins from the gut into the circulation. It is a new development the use of the serum procalcitonin level for the diagnosis, differential-diagnosis and for the evaluation of the success of the therapy. The causal therapy of the sepsis is still the surgical management of the septic focus, which should be supported by antibiotics and non-specific treatment (fluid-load, ventilation, inotropic, vasoactive and immunogenic drugs). It is new knowledge the effect of antibiotics on the immuno-system. For the treatment of SIRS, it has been tried many anti-cytokine and immunomodulating therapy; author explains the presumable causes of the failure of their majority.
D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000276:immunology / Q000628:therapy; D003422:Critical Care; D006801:Humans; D009104:Multiple Trauma / Q000628:therapy; D018805:Sepsis / Q000628:therapy*; D012772:Shock, Septic / Q000628:therapy