System interactions.
The paradigm of sepsis as an excessive inflammatory response to infection should now be extended to include activation and/or depression of numerous systems within the body. These include neural, immune, hormonal, bioenergetic and metabolic pathways. The levels of activity of these systems vary both with illness severity and over time. Perturbation of the components of each pathway is independently associated with a heightened mortality risk yet interactions and temporal relationships remain poorly understood. A better delineation of this intricate network and an enhanced ability to monitor these changes should lead to improved targeting of interventions and an avoidance of potentially harmful therapeutic strategies. In addition, greater recognition of the deleterious covert effects on these systems of many therapies currently established as standard management, for example inotropes, antibiotics and sedatives, should hopefully minimise the iatrogenic contribution to mortality and morbidity.
Singer
Mervyn
M
Bloomsbury Institute of Intensive Care Medicine, Dept of Medicine and Wolfson Institute of Biomedical Research, University College London, Gower Street, London WC1E 6BT, UK.
D004359:Drug Therapy, Combination; D006801:Humans; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy* / Q000503:physiopathology