title: Immune-modulating interventions in critically ill septic patients: pharmacological options.
abstract: Critically ill patients with severe sepsis and septic shock are characterized by a systemic inflammatory response consisting of pro- and anti-inflammatory mediators. Owing to the high mortality of severe sepsis, great efforts have been undertaken within the last 30 years to develop an immune-modulating therapy to improve survival. Relatively few pharmacological immune-modulating interventions have demonstrated a beneficial impact on survival, while other studies have shown a detrimental effect of such interventions. Among the immune-modulating interventions tested, activated protein C and intensive insulin therapy have been shown to improve survival in septic patients. However, in later studies, it has been difficult to reproduce these beneficial effects. There appears to be a discrepancy between the promising effects of immune-modulating interventions in animal studies and the effects seen in the clinical setting. In the future, the onset of the proinflammatory versus the anti-inflammatory response must be better defined and the timing of treatment with immune-modulating agents should be better managed.
authors: Odense University Hospital, DK-5000 Odense C, Denmark.
authors: Palle
authors: P
authors: Toft
authors: Else
authors: E
authors: Tønnesen
mesh_terms: D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D018836:Inflammation Mediators / Q000627:therapeutic use; D011486:Protein C / Q000378:metabolism; D018805:Sepsis / Q000188:drug therapy* / Q000276:immunology* / Q000378:metabolism
chemical_list: D000893:Anti-Inflammatory Agents; D007155:Immunologic Factors; D018836:Inflammation Mediators; D011486:Protein C