New treatment strategies for severe sepsis and septic shock.
OBJECTIVE
Severe sepsis and septic shock are common causes of morbidity and mortality in critically ill patients. The complexities of the septic cascade continue to emerge and may identify new targets for innovative patient management. This review will highlight some of the recent advances in our management of the patient with sepsis.


RESULTS
The early administration of adequate antibiotic therapy, effective source control, and goal-directed hemodynamic resuscitation are the cornerstone of successful management. Prevention of the complications of critical illness and maintenance of normal glucose levels are also important elements of effective management. In patients with vasopressor-dependent septic shock, evaluation for inadequate cortisol response and the provision of physiologic doses of replacement steroids for those found to be deficient may result in improved survival. Administration of drotrecogin alfa (activated), (activated protein C) has been shown to improve survival in patients with severe sepsis and septic shock who have a high risk of mortality. Because of its anticoagulant properties, caution must be exercised with the use of activated protein C in those patients who meet the contraindications for its use or who have risk factors for increased bleeding complications.


CONCLUSIONS
Significant advances have been made in our understanding of the septic cascade and our ability to manage patients with severe sepsis and septic shock. Despite these advances, significant morbidity and mortality continue. In addition, there is also considerable impact on the financial and overall function of the patient.
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003422:Critical Care; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy / Q000517:prevention & control; D007328:Insulin / Q000008:administration & dosage; D009638:Norepinephrine / Q000627:therapeutic use; D011379:Prognosis; D011486:Protein C / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D018805:Sepsis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D012122:Ventilators, Mechanical
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007328:Insulin; D011486:Protein C; D011994:Recombinant Proteins; D014662:Vasoconstrictor Agents; C421124:drotrecogin alfa activated; D009638:Norepinephrine