Sepsis: state of the art.
In recent years, we have considerably widened our knowledge of the pathophysiology of sepsis and some procedures, aiming both to relieve symptoms and control the inflammation/coagulation reaction, have proven to be effective in increasing survival. This improves when mechanical ventilation is applied with low tidal volumes, fluid replacement and the use of cardioactive drugs are titrated on the oxygen saturation of hemoglobin in the central venous system and blood glucose does not exceed certain limits. It is also evident that inflammation and coagulation are closely related to each other. The inhibition of only one pathway, such as the inhibition of inflammation with high dosage steroids or the inhibition of coagulation with antithrombin, does not produce a survival improvement. The only molecule which has proven to be notably effective in reducing mortality is Activated Protein C interacting on coagulation/fibrinolysis, as well as on inflammation processes. Multinodal modulation of several interdependent processes may be the probable reason for the proven effectiveness of this treatment.
Gattinoni
L
L
Department of Anesthesiology, Ospedale Maggiore Policlinico IRCCS, Milano University of Milan, Milan, Italy. gattinon@polic.cilea.it
Vagginelli
F
F
Taccone
P
P
Carlesso
E
E
Bertoja
E
E
D001798:Blood Proteins / Q000502:physiology; D006801:Humans; D008954:Models, Biological; D009102:Multiple Organ Failure / Q000209:etiology; D011486:Protein C / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D018746:Systemic Inflammatory Response Syndrome / Q000145:classification / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy
D001798:Blood Proteins; D011486:Protein C; D011994:Recombinant Proteins