[Non-infective treatments for septic shock].
"Severe sepsis" is defined by organ dysfunction due to infection-induced hypoperfusion. "Septic shock" is defined by hypotension refractory to fluid resuscitation, associated with organ dysfunctions or hypoperfusion. Mortality from severe sepsis and from septic shock is high. Guidelines to help physicians improve the survival of patients with severe sepsis comprise one part of an international project called the Surviving Sepsis Campaign. They bring together treatment innovations based on monitoring aimed at ensuring comprehensive management of tissue oxygen levels (central venous oxygen saturation: SvcO2). They are based on the optimization of early treatment, during the first six hours of severe sepsis, and ensuring no delay in fluid resuscitation. In case of septic shock, fluid resuscitation must be rapidly accompanied by administration of vasoconstrictive catecholamines. Noradrenaline is preferred to dopamine. Dobutamine is recommended when the cardiac index is less than 2.5 L x min(-1) x m(-2). Because of the relative adrenal insufficiency that occurs during septic shock, corticoids are recommended, after a synacthen test. Activated protein C is currently the only therapy produced by biotechnology that reduces mortality from severe sepsis. Global management of septic shock must form an integral part of resuscitation guidelines and include protocols for, among other things, sedation, ventilation, strict glycemic control, and prophylaxis for deep vein thrombosis and stress ulcers.
Clinique d'Anesthésie et Réanimation, Hôpital Claude Huriez, Lille. bvallet@chru-lille.fr
Benoît
B
Vallet
Eric
E
Wiel
Gilles
G
Lebuffe
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001779:Blood Coagulation Factors / Q000502:physiology; D002395:Catecholamines / Q000097:blood; D006801:Humans; D009638:Norepinephrine / Q000627:therapeutic use; D011956:Receptors, Cell Surface / Q000502:physiology; D012772:Shock, Septic / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D000893:Anti-Inflammatory Agents; D001779:Blood Coagulation Factors; D002395:Catecholamines; D011956:Receptors, Cell Surface; D014662:Vasoconstrictor Agents; C091963:activated protein C receptor; D009638:Norepinephrine