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Management of septic shock: current concepts, with a particular emphasis on the role of source control, and future perspectives

  • A. G. Tsiotou (a1) and G. H. Sakorafas (a2)

Abstract

Summary

Sepsis is an infection-induced syndrome characterized by a generalized inflammatory state. The normal reaction to infection involves a series of complex immunological processes. A potent, complex immunological cascade ensures a prompt protective response to microbial invasion in human beings. Although activation of the immune system during microbial invasion is generally protective, septic shock develops in a number of patients as a consequence of excessive or poorly regulated immune response to the offending organism. This unbalanced reaction may harm the host through a maladaptive release of endogenously generated inflammatory compounds. Early recognition of the syndrome is of key importance to promptly start appropriate management. Timely, aggressive resuscitation to preserve organ function remains a fundamental principle in the care of septic patients. The specific treatment is directed at identifying and treating the underlying disorder. The physician should investigate diligently for the presence of active infection using modern imaging methods and other diagnostic studies to localize the site of infection and to obtain adequate culture specimens from potential infective sources. Early administration of appropriate, effective antibiotic therapy is important in the management of septic patients. Infected fluid collections and/or infected necrotic tissues should be drained or debrided without delay. Adequate nutritional support is indicated in the management of the septic patient. A number of adjuvant therapies, aimed at blunting/downregulating the host immune response to bacterial infection are currently under intensive investigation; however, the complexity of immunological defences and the potential for complementary interaction of the different components of the inflammatory cascade make the development of these pharmacological interventions difficult.

Copyright

Corresponding author

Correspondence to: George Sakorafas, Department of Surgery, 251 Hellenic Air Force Hospital, Arkadias 19-21, GR-115 26 Athens, Greece. E-mail: georgesakorafas@yahoo.com; Tel: +30 210 7487 318; Fax: +30 210 7487 192

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References

Baker CC, Huynh T. Sepsis in the critically ill patient. Curr Probl Surg 1995; 32: 10151083.
Carcillo JA. Pediatric septic shock and multiple organ failure. Crit Care Clin 2003; 19: 413440.
Bone RC. Sepsis syndrome; new insights into its pathogenesis and treatment. Infect Dis Clin North Am 1991; 5: 793805.
Wheeler AP, Bernard GR. Treating patients with severe sepsis. New Engl J Med 1999; 340: 207214.
Hardaway RM. A review of septic shock. Am Surg 2000; 66: 2229.
Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP. The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 1995; 273: 117123.
Sakorafas GH. Multiple Organ Failure Syndrome (Monograph).Athens, Greece: Diaton Publications, 1990: 150.
Hebert PC, Drummond AJ, Singer J, Bernard GR, Russell JA. A simple multiple system organ failure scoring system predicts mortality of patients who have sepsis syndrome. Chest 1993; 104: 230235.
Balk RA. Pathogenesis and management of multiple organ dysfunction or failure in severe sepsis and septic shock. Crit Care Clin 2000; 16: 337352.
Piper RD, Sibbald WJ. Multiple organ dysfunction syndrome: the relevance of persistent infection and inflammation. In: Fein AM, Abraham ED, Balk RA, et al., eds. Sepsis and Multiorgan Failure.Baltimore, USA:Williams & Wilkins, 1997: 189208.
Light RB. Septic shock. In: Hall JB, Schmidt GA, Wood LDH, eds. Principles of Critical Care.New York, USA: McGraw-Hill, 1992: 11721185.
Field S, Kelly SM, Macklem PT. The oxygen cost of breathing with cardiorespiratory disease. Am Rev Respir Dis 1982; 126: 913.
Martin GS, Bernard GR. Airway and lung in sepsis. Intens Care Med 2001; 27: S63S79.
Tobin MJ. Mechanical ventilation. New Engl J Med 1994; 330: 10561061.
Stoller JK. Current controversies in applying specific modes of mechanical ventilation. In: Hall JB, Schmidt GA, Wood LDH, eds. Principles of Critical Care.New York, USA: McGraw-Hill, 1992: 155159.
Carmichael LC, Dormisky PM, Higgins SB, et al. Diagnosis and therapy of acute respiratory distress syndrome in adults: an international survey. J Crit Care 1996; 11: 918.
Hickling KG. Permissive hypercapnia. Respir Care Clin North Am 2002; 8: 155169.
McHugh LG, Milberg JA, Whitcomb ME, Schoene RB, Maunder RJ, Hudson LD. Recovery of function in survivors of the acute respiratory distress syndrome. Am J Respir Crit Care Med 1994; 150: 9094.
Hall JB, Wood LDH. Liberation of the patient from mechanical ventilation. JAMA 1987; 257: 16211627.
Pulmonary artery catheter consensus conference: consensus statement. Crit Care Med 1997; 25: 910925.
Connors JrAF, Speroff T, Dawson NV, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA 1996; 276: 889897.
Abou-Khalil B, Scalea TM, Trooskin SZ, Henry SM, Hitchcock R. Hemodynamic responses to shock in young trauma patients: need for intensive monitoring. Crit Care Med 1994; 22: 633639.
Vincent JL. Hemodynamic support in septic shock. Intens Care Med 2001; 27: S80S92.
Rackow EC, Falk JL, Fein IA, et al. Fluid resuscitation in septic shock. Crit Care Med 1983; 11: 839850.
Meumann M, Demling RH. Colloid vs. crystalloid: a current perspective. Confed Aust Crit Care Nurses J 1990; 3: 3035.
Levine R, Alvarez FG. Intravenous fluid therapy. Hosp Physician 1994; 30: 2137.
Velanovich V. Crystalloid versus colloid fluid resuscitation: meta-analysis of mortality. Surgery 1989; 105: 6571.
Bunnell E, Parrillo JE. Cardiac dysfunction during septic shock. Clin Chest Med 1996; 17: 237248.
Walley KR, Wood LDH. Cardiovascular disorders in the critically ill. In: Hall JB, Schmidt GA, Wood LDH, eds. Principles of Critical Care.New York, USA: McGraw-Hill, 1992: 13931416.
Mileski WJ. Sepsis. Surg Clin North Am 1991; 71: 749764.
Hayes MA, Yau EHS, Timmins AC, Hinds CJ, Watson D. Response of the critically ill patients to treatment aimed at achieving supranormal oxygen delivery and consumption. Chest 1993; 103: 886895.
Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis: a prospective, controlled clinical study. Ann Intern Med 1990; 112: 492498.
Boyd O, Grounds M, Bennett ED. A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. JAMA 1993; 270: 26992707.
Russell JA, Phang PT. The oxygen delivery/consumption controversy: approaches to management of the critically ill. Am J Respir Crit Care Med 1995; 149: 533537.
Gattinoni L, Brazzi L, Pelosi P, et al. A trial of goal-oriented hemodynamic therapy in critically ill patients. New Engl J Med 1995; 333: 10251032.
Hebert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. New Engl J Med 1999; 340: 409417.
Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D. Elevation of systemic oxygen delivery in the treatment of critically ill patients. New Engl J Med 1994; 330: 17171722.
Marik PE, Sibbald WI. Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA 1993; 269: 30243029.
Light RB. Sepsis syndrome. In: Hall JB, Schmidt GA, Wood LDH, eds. Principles of Critical Care.New York, USA: McGraw-Hill, 1992: 645655.
Wheeler A, Carmichael L, Christman B, et al. Renal function abnormalities in sepsis. Am J Respir Crit Care Med 1995; 151 (Suppl): A317.
Marini JJ, Wright L. General supportive care of the critically ill patient. Semin Respir Crit Care Med 1997; 18: 317.
Cook D. Prevention of stress ulcers and ventilator-associated pneumonia. Semin Respir Crit Care Med 1997; 18: 9195.
Jain M, Schmidt GA. Venous thromboembolism: prevention and prophylaxis. Semin Respir Crit Care Med 1997; 18: 7990.
Llewelyn M, Cohen J. Diagnosis of infection in sepsis. Intens Care Med 2001; 27: S10S32.
Butt W. Septic shock. Pediatr Clin North Am 2001; 48: 601625.
Kreger BE, Craven DE, McCabe WR. Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med 1980; 68: 344355.
Simon D, Trenholme G. Antibiotic selection for patients with septic shock. Crit Care Clin 2000; 16: 215231.
Pittet D, Thievent B, Wenzel RP, Li N, Auckenthaler R, Suter PM. Bedside prediction of mortality from bacteremic sepsis: a dynamic analysis of ICU patients. Am J Respir Crit Care Med 1996; 153: 684693.
Stone HH, Bourneuf AA, Stinson LD. Reliability of criteria for predicting persistent or recurrent sepsis. Arch Surg 1985; 120: 1720.
Gold H, Moellering R. Antimicrobial-drug resistance. New Engl J Med 1996; 335: 14451448.
Smith T, Pearson M, Wilcox K, et al. Emergence of vancomycin resistance in Staphylococcal aureus. New Engl J Med 1999; 340: 493498.
Friedland I, McCracken G. Management of infections caused by antibiotic-resistant Streptococcus pneumoniae. New Engl J Med 1994; 331: 377381.
Chen D, McGeer A, de Azavedo J, Low DE. Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. New Engl J Med 1999; 341: 233238.
Craig WA. Qualitative susceptibility tests versus quantitative MIC tests. Diagn Microbiol Infect Dis 1993; 16: 231236.
Hurley JC. Antibiotic-induced release of endotoxin: a reappraisal. Clin Infect Dis 1992; 15: 8492.
Jenkins JK, Carey PD, Byrne K, Sugerman HJ, Fowler III AA. Sepsis-induced lung injury and effects of ibuprofen pretreatment: analysis of early alveolar events via repetitive bronchoalveolar lavage. Am Rev Respir Dis 1991; 143: 155161.
Stillwell M, Caplan ES. The septic multiple trauma patient. Infect Dis Clin North Am 1989; 3: 155183.
Brun-Buisson C, Doyon F, Carlet J. Bacteremia and severe sepsis in adults: a multicenter prospective survey in ICUs and wards of 24 hospitals. Am J Respir Crit Care Med 1996; 154: 617624.
Bohnen JM, Solomkin JS, Dellinger PE, Bjornson HS, Page CP. Guidelines for clinical care; anti-infection agents for intra-abdominal infection. A surgical infection society policy statement. Arch Surg 1992; 127: 8389.
Jimenez MF, Marshall JC. Source control in the management of sepsis. Intens Care Med 2001; 27: S49S62.
Sprung CL, Finch RG, Thijs LG, Glauser MP. International sepsis trial (INTERSEPT): role and impact of a clinical evaluation committee. Crit Care Med 1996; 24: 14411447.
Sakorafas GH. Multi-organ failure as an indication for exploratory laparotomy. Arch Hellenic Surg (Gr) 1989; 56: 3742.
Kaul R, McGeer A, Low DE, Green K, Schwartz B. Population-based surveillance for group A streptococcal necrotizing fasciitis: clinical features, prognostic indicators, and microbiological analysis of seventy-seven cases. Ontario group A streptococcal study. Am J Med 1997; 103: 1824.
Eriksson B, Andersson J, Holm SE, Norgren M. Epidemiological and clinical aspects of invasive group A streptococcal infection and the streptococcal toxic shock syndrome. Clin Infect Dis 1998; 27: 14281436.
Majeski JA, Alexander JW. Early diagnosis and surgical treatment of necrotizing fasciitis. Surg Gynecol Obstet 1983; 157: 784807.
Moss RL, Musemeche CA, Kosloske AM. Necrotizing fasciitis in children: prompt recognition and aggressive therapy improve survival. J Pediatr Surg 1996; 31: 11421146.
Adant JP, Bluth F, Fissetter J. Necrotizing fasciitis; a life-threatening infection. Acta Chir Belg 1998; 98: 102106.
Condon RE. Necrotizing skin and soft tissue infections. In: Rakel R, ed. Conn's Current Therapy.Philadelphia, USA: WB Saunders, 1998: 8790.
Bilton BD, Zibari GB, McMillan RW, Aultman DF, Dunn G, McDonald JC. Aggressive surgical management of necrotizing fasciitis serves to decrease mortality; a retrospective study. Am Surg 1998; 64: 397400.
Lewis RT. Soft tissue infections. World J Surg 1998; 22: 146155.
Brown G, Chamberlain R, Goulding J, Clarke A. Ceftriaxone versus cefazolin with probenecid for severe skin and soft tissue infections. J Emerg Med 1996; 14: 547551.
McHenry CR, Brandt CP, Piotrowski JJ, Jacobs DG, Malagnoni MA. Idiopathic necrotizing fasciitis; recognition, incidence, and outcome of therapy. Am Surg 1994; 60: 490494.
Davies HD, McGeer A, Schartz B, et al. The Ontario group A streptococcal study group. Invasive group A streptococcal infections in Ontario, Canada. New Engl J Med 1996; 335: 547554.
Nichols RL. Diagnosis and treatment of uncomplicated and complicated surgical infections. Surgery 2000; 128: S19S30.
Laor E, Palmer LS, Tolia BM, Reid RE, Winter HI. Outcome prediction in patients with Fournier's gangrene. J Urol 1995; 154: 8992.
Bartlet P, Reingold AL, Graham DR, et al. Toxic shock associated with surgical wound infection. JAMA 1982; 247: 14481450.
Norrby-Teglud A, Low DE, McGeer A, Kotb M. Superantigenic activity produced by group A streptococcal isolates is neutralized by plasma from IVIG-treated streptococcal isolates is neutralized by plasma from IVIG-treated streptococcal toxic shock syndrome patients. Adv Exp Med Biol 1997; 418: 563566.
Fry DE. Toxic shock syndrome. In: Fry DE, ed. Surgical Infection.Boston, USA: Little Brown, 1995: 569576.
Sirinek KR. Diagnosis and treatment of intra-abdominal abscesses. Surg Infect 2000; 1: 3138.
Montgomery RS, Wilson SE. Intraabdominal abscesses: image-guided diagnosis and therapy. Clin Infect Dis 1996; 23: 2836.
Barkhausen J, Stoblen F, Dominguez-Fernandez E, Henseke P, Muller RD. Impact of CT in patients with sepsis of unknown origin. Acta Radiol 1999; 40: 552555.
Lal NR, Kazerooni EA, Bree RL. Development and implementation of an appropriateness guideline for use of CT in cases of suspected intraabdominal abscess. Acad Radiol 2000; 7: 711716.
Levison MA. Percutaneous versus open operative drainage of intra-abdominal abscesses. Infect Dis Clin North Am 1992; 6: 525544.
Khurrum Baig M, Hua Zhao R, Batista O, et al. Percutaneous postoperative intra-abdominal abscess drainage after elective colorectal surgery. Tech Coloproctol 2002; 6: 159164.
Marano I, Mainenti PP, Selva G, Cannavale M, Sodano A. Computerized tomography-guided drainage of postoperative abdominal fluid collections. Radiol Med 1999; 97: 160165.
Bufalari A, Giustozzi G, Moggi L. Postoperative intraabdominal abscesses: percutaneous versus surgical treatment. Acta Chir Belg 1996; 96: 197200.
Thanos L, Dailiana T, Papaioannou G, Nikita A, Koutrouvelis H, Kelekis DA. Percutaneous CT-guided drainage of splenic abscess. Am J Roentgenol 2002; 179: 629632.
Lankisch PG, Pflichthofer D, Lehnick D. No strict correlation between necrosis and organ failure in severe acute pancreatitis. Pancreas 2000; 20: 319322.
Bassi C, Falconi M, Girelli F, et al. Microbiological findings in severe pancreatitis. Surg Res Commun 1989; 5: 14.
Isenmann R, Rau B, Beger HG. Bacterial infection and extent of necrosis are determinants of organ failure in patients with acute necrotizing pancreatitis. Br J Surg 1999; 86: 10201024.
Gloor B, Muller CA, Worni M, Mantignoni ME, Uhl W, Buchler MW. Late mortality in patients with severe acute pancreatitis. Br J Surg 2001; 88: 975979.
Banks PA, Gerzof SG, Langevin RE, Silverman SG, Sica GT, Hughes MD. CT-guided aspiration of suspected pancreatic infection: bacteriology and clinical outcome. Int J Pancreatol 1995; 18: 265270.
British Society of Gastroenterology: United Kingdom guidelines for the management of acute pancreatitis. Gut 1998; 42 (Suppl 2): S1S13.
Uhl W, Warshaw A, Imrie C, et al. IAP guidelines for the surgical management of acute pancreatitis. Pancreatology 2002; 2: 565573.
Widdison AL, Karanjia ND. Pancreatic infection complicating acute pancreatitis. Br J Surg 1993; 80: 148154.
Buchler MW, Gloor B, Muller CA, Friess H, Seiler CA, Uhl W. Acute necrotizing pancreatitis. Treatment strategy according to the status of infection. Ann Surg 2000; 232: 619626.
Fernandez-del Castillo C, Rattner DW, Makary MA, Mostafavi A, McGrath D, Warshaw AL. Debridement and closed packing for the treatment of necrotizing pancreatitis. Ann Surg 1998; 228: 676684.
Sarr MG, Nagorney DM, Mucha PJ, Farnell MB, Johnson CD. Acute necrotizing pancreatitis: management by planned, staged pancreatic necrosectomy/debridement and delayed primary wound closure over drains. Br J Surg 1991; 78: 576581.
Tenner S, Sica G, Hughes M, et al. Relationship of necrosis to organ failure in severe acute pancreatitis. Gastroenterology 1997; 113: 899903.
Rau B, Pralle U, Uhl W, Schoenberg MH, Berger HG. Management of sterile necrosis in instances of severe acute pancreatitis. J Am Coll Surg 1995; 181: 279288.
Hartwing W, Maksan SM, Foitzk T, Schmidt J, Herfarth C, Klar E. Reduction in mortality with delayed surgical therapy of severe pancreatitis. J Gastrointest Surg 2002; 6: 481487.
Kivilaakso E, Fraki O, Nikki P, Lempinen M. Resection of the pancreas for acute fulminant pancreatitis. Surg Gynecol Obstet 1981; 152: 493498.
Mier J, Leon EL, Castillo A, Robledo F, Blanco R. Early versus late necrosectomy in severe necrotizing pancreatitis. Am J Surg 1997; 173: 7175.
Baron TH, Thaggard WG, Morgan DE, Stanley RJ. Endoscopic therapy for organized pancreatic necrosis. Gastroenterology 1996; 111: 755764.
Carter CR, McKay CJ, Imrie CW. Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pancreatic necrosis; an initial experience. Ann Surg 2000; 232: 175180.
Tsiotos GG, Luque-de Leon E, Soreide JA, et al. Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique. Am J Surg 1998; 175: 9198.
Schierholz JM, Beuth J. Implant infections: a haven for opportunistic bacteria. J Hosp Infect 2001; 49: 8793.
von Eiff C, Peters G, Heilmann C. Pathogenesis of infections due to coagulase-negative staphylococci. Lancet Infect Dis 2002; 2: 677685.
Vandecasteele SJ, Van Wijngaerden E, Van Eldere J, Peetermans WE. New insights in the pathogenesis of foreign body infections with coagulase negative staphylococci. Acta Clin Belg 2000; 55: 148153.
Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous catheter-related infection. New Engl J Med 1977; 296: 13051309.
Sherertz RJ, Heard SO, Raad II. Diagnosis of triple-lumen catheter infection: comparison of roll-plate, sonication, and flushing methodologies. J Clin Microbiol 1997; 35: 641646.
Cook DJ, Randolph A, Kernerman P, et al. Central venous catheter replacement strategies: a systemic review of the literature. Crit Care Med 1997; 25: 14171424.
Maki D, Stolz S, Wheeler S, Mermel LA. Prevention of central venous catheter-related blood-stream infection by use of an antiseptic-impregnated catheter. Ann Intern Med 1997; 127: 257266.
Clarke DE, Raffin TA. Infectious complications of indwelling long-term central venous catheters. Chest 1990; 97: 966972.
Murray CK, Beckius ML, McAllister K. Fusarium proliferatum superficial suppurative thrombophlebitis. Mil Med 2003; 168: 426427.
Timsit JF. Scheduled replacement of central venous catheters is not necessary. Infect Cont Hosp Epidemiol 2000; 21: 371374.
Bregenzer T, Conen D, Sakmann P, Widmer AF. Is routine replacement of peripheral intravenous catheters necessary? Arch Intern Med 1998; 158: 151156.
Gajic O, Urrutia LE, Sewani H, Schroeder DR, Cullinane DC, Peters SG. Acute abdomen in the medical intensive care unit. Crit Care Med 2002; 30: 11871190.
Kollef MH, Allen BT. Determinants of outcome for patients in the medical intensive care unit requiring abdominal surgery: a prospective, single-center study. Chest 1994; 106: 18221828.
Gregor P, Prodger JD. Mead Johnson Critical Care Symposium for the Practicing Surgeon. Abdominal crisis in the intensive care unit. Can J Surg 1988; 31: 331332.
Stapakis JC, Thickman D. Diagnosis of pneumoperitoneum: abdominal CT vs. upright chest film. J Comput Assist Tomogr 1992; 16: 713716.
Jacobs JE, Birnbaum BA. Abdominal computed tomography of intensive care unit patients. Semin Roentgenol 1997; 32: 128141.
Boland GW, Slater G, Lu DS, Eisenberg P, Lee MJ, Mueller PR. Prevalence and significance of gallbladder abnormalities seen on sonography in intensive care unit patients. Am J Roentgenol 2000; 174: 973977.
Walsh RM, Popovich MJ, Hoadley J. Bedside diagnostic laparoscopy and peritoneal lavage in the intensive care unit. Surg Endosc 1998; 12: 14051409.
Byrne MF, Suhocki P, Mitchell RM, et al. Percutaneous cholecystostomy in patients with acute cholecystitis: experience of 45 patients at a US referral center. J Am Coll Surg 2003; 197: 206211.
Akhan O, Akinci D, Ozmen MN. Percutaneous cholecystostomy. Eur J Radiol 2002; 43: 229236.
Gouma DJ. Management of acute cholangitis. Digest Dis 2003; 21: 2529.
Gedebou TM, Wong RA, Rappaport WD, Jaffe P, Kahsai D, Hunter GC. Clinical presentation and management of iatrogenic colon perforations. Am J Surg 1996; 172: 454458.
Jentschura D, Raute M, Winter J, Henkel T, Kraus M, Magegold BC. Complications in endoscopy of the lower gastrointestinal tract. Therapy and prognosis. Surg Endosc 1994; 8: 672676.
Liolios A, Oropello JM, Benjamin E. Gastrointestinal complications in the intensive care unit. Clin Chest Med 1999; 20: 329324.
Polk HC, Shields CL. Remote organ failure: a valid sign of occult intraabdominal infection. Surgery 1977; 81: 310313.
Fry DE, Pearlstein L, Fulton RL, Polk HC. Multiple system organ failure: the role of uncontrolled infection. Arch Surg 1980; 115: 136140.
Ferraris VA. Exploratory laparotomy for potential abdominal sepsis in patients with multiple organ failure. Arch Surg 1983; 118: 11301133.
Bunt TJ. Non-directed relaparotomy for intraabdominal sepsis; a futile procedure. Am Surg 1986; 52: 294298.
McCrory C, Crowley K. Is repeat laparotomy of value in patients with suspected intraabdmominal sepsis in the intensive care unit? Ir J Med Sci 1997; 166: 8991.
Grant JP. Nutritional support in critically ill patients. Ann Surg 1994; 220: 610616.
Moore FA, Feliciano DV, Andrassy RJ, et al. Early enteral feeding, compared with parenteral, reduces postoperative septic complications; the results of a meta-analysis. Ann Surg 1992; 216: 172183.
Kudsk KA, Stone JM, Carpenter G, Sheldon GF. Enteral and parenteral feeding influences mortality after hemoglobin E. Coli peritonitis in normal rats. J Trauma 1983; 23: 605609.
Kudsk KA. Gut mucosal nutritional support. Enteral nutrition as primary therapy after multiple system trauma. Gut 1994; 35 (Suppl 1): S52S54.
Sakorafas GH, Krespis EN. Methods of enteral nutrition. Iatriki 1992; 61: 482491.
Sakorafas GH. Enteral nutrition in Surgery. Hell Armed Force Med Rev 1992; 26: 129148.
Cerra FB, Benitez MR, Blackburn GL, et al. Applied nutrition in ICU patients; a consensus statement of the American College of Chest Physicians. Chest 1997; 111: 769778.
Singh G, Harkema JM, Mayberry AJ, Chaudry IH. Severe depression of gut absorptive capacity in patients following trauma or sepsis. J Trauma 1994; 36: 803809.
Singh G, Chaudry KI, Chudler LC, Chaudry IH. Sepsis produces early depression of gut absorptive capacity restoration with diltiazem treatment. Am J Physiol 1992; 263: R19R23.
Long C. Metabolic response to injury and illness. Estimation of energy and protein needs from indirect calorimetry and nitrogen balance. J Parenter Enter Nutr 1979; 3: 452456.
McCarthy MC. Nutritional support in the critically ill surgical patient. Surg Clin North Am 1991; 71: 831841.
Kalfarentzos J. Nutritional Support. Athens, Greece: Litsas, 1986: 1130.
Clevenger FW. Nutritional support in the patient with the systemic inflammatory response syndrome. Am J Surg 1993; 165 (Suppl 2A): 68S74S.
Koretz RL. Nutritional supplementation in the ICU: how critical is nutrition for the critically ill? Am J Respir Crit Care Med 1995; 151: 570573.
Glauser MP. Pathophysiologic basis of sepsis; considerations for future strategies of intervention. Crit Care Med 2000; 28 (Suppl): S4S8.
Neugebauer E, Rixen D, Raum M, Schafer U. Thirty years of anti-mediator treatment in sepsis and septic shock: What have we learned? Langenbecks Arch Surg 1998; 383: 2634.
Zeni F, Freeman B, Natanson C. Anti-inflammatory therapies to treat sepsis and septic shock: a reassessment. Crit Care Med 1997; 25: 10951100.
Kox WJ, Volk T, Kox SN, Volk HD. Immunomodulatory therapies in sepsis. Intens Care Med 2000; 26: S124S128.
Abraham E, Anzueto A, Cutierrez G, et al. Double-blind randomised controlled trial of monoclonal antibody to human tumor necrosis factor in treatment of septic shock. Lancet 1998; 351: 929933.
Bone RC, Balk RA, Fein AM, et al. A second large controlled study of E5, a monoclonal antibody to endotoxin: results of a prospective, multicenter, randomised, controlled trial. Crit Care Med 1995; 23: 9941006.
Angus DC, Birmingham D, Balk RA, et al. E5 murine monoclonal antiendotoxin antibody in gram-negative sepsis: a randomized controlled trial. E5 Study Investigators. JAMA 2000; 283: 17231730.
Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. New Engl J Med 2003; 348: 138150.
Czermak BJ, Sarma V, Pierson CL, et al. Protective effects of C5a blockade in sepsis. Nat Med 1999; 5: 788792.
Guo RF, Huber-Lang M, Wang X, et al. Protective effects of anti-C5a in sepsis-induced thymocyte apoptosis. J Clin Invest 2000; 106: 12711280.
Huber-Lang MS, Sarma JV, McGuire SR, et al. Protective effects of anti-C5a peptide antibodies in experimental sepsis. FASEB J 2001; 15: 568570.
Rogiers P. Hemofiltration treatment for sepsis; is it time for controlled trials? Kidney Int 1999; 56 (Suppl 72): S99S103.
Gotloid L, Shostak A, Lev A, Fudin R, Jaichenko J. Treatment of surgical and non-surgical septic multiorgan failure with bicarbonate hemodialysis and sequential hemofiltration. Intens Care Med 1995; 21: 104111.
Bellomo R, Balwin I, Cole Ronco C. Preliminary experience with high-volume hemofiltration in human septic shock. Kidney Int 1998; 54 (Suppl 66): S182S185.
Boulain T, Delpech M, Legras A, et al. Continuous venovenous hemofiltration in acute renal failure associated with multiple organ failure: influence on outcome. Clin Intens Care 1996; 7: 410.
Schiffl H, Lang SM, Fischer R. Daily hemodialysis and the outcome of acute renal failure. New Engl J Med 2002; 346: 305310.
Kollef MH. Opinion: the clinical use of selective digestive decontamination. Crit Care 2000; 4: 327332.
Bonten MJ, Kullberg BJ, van Dalen R, et al. Selective digestive decontamination in patients in intensive care. The Dutch Working Group on Antibiotic Policy. J Antimicrob Chemother 2000; 46: 351362.
Sprung CL, Caralis PV, Marcial EH, et al. The effects of high-dose corticosteroids in patients with septic shock. New Engl J Med 1984; 311: 11371143.
Cronin L, Cook DJ, Carlet J, et al. Corticosteroid treatment for sepsis; a critical reappraisal and meta-analysis of the literature. Crit Care Med 1995; 23: 14301439.
Annane D, Sebille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002; 288: 862871.
Briegel J, Forst H, Haller M, et al. Stress doses of hydrocortisone reverse hyperdynamic septic shock; a prospective, randomized, double-blind, single-center study. Crit Care Med 1999; 27: 723732.
Boellaert PE, Charpentier C, Levy B, Debouverie M, Audibert G, Larcan A. Reversal of late septic shock with suprephysiologic doses of hydrocortisone. Crit Care Med 1998; 26: 645650.
Spijkstra JJ, Girbes ARJ. The continuing story of corticosteroids in the treatment of septic shock. Intens Care Med 2000; 26: 496500.
Annane D. Corticosteroids for septic shock. Crit Care Med 2001; 29 (Suppl): S117S120.
Zaloga GP. Sepsis-induced adrenal deficiency syndrome. Crit Care Med 2001; 29: 688690.
Shenker Y, Skatrud JB. Adrenal insufficiency in critically ill patients. Am J Respir Crit Care Med 2001; 163: 15201523.
Annane D, Sebille V, Troche G, Raphael JC, Gajdos P, Bellissant E. A 3-level prognostic classification in septic shock based on cortisol levels and cortisol response to corticotrophin. JAMA 2000; 283: 10381045.
Abraham E, Evans T. Corticosteroids and septic shock. JAMA 2002; 288: 886887.
Arons MM, Wheeler AP, Bernard GR, et al. Effects of ibuprofen on the physiology and survival of hypothermic sepsis. Ibuprofen in Sepsis Study Group. Crit Care Med 1999; 27: 699707.
Bernard GR, Wheeler AP, Russell JA, et al. Effects of ibuprofen on the physiology and survival of patients with sepsis. New Engl J Med 1997; 336: 912918.
Bernard GR, Vincent JL, Laterre PF, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. New Engl J Med 2001; 344: 699709.
Matthay MA. Severe sepsis – a new treatment with both anticoagulant and anti-inflammatory properties. New Engl J Med 2001; 344: 759762.
Joyce DE, Gelbert L, Ciaccia A, DeHoff B, Grinnell BW. Gene expression profile on antithrombotic protein C defines new mechanisms modulating inflammation and apoptosis. J Biol Chem 2001; 276: 1119911203.
Cohen J, Guyatt G, Bernard GR, et al. New strategies for clinical trials in patients with sepsis and septic shock. Crit Care Med 2001; 29: 880886.
Quartin AA, Schein RM, Kett DH, Peduzzi PN. Magnitude and duration on the effect of sepsis on survival. Department of Veterans Affairs Systemic Sepsis Cooperative Studies Group. JAMA 1997; 277: 10581063.
Warren HS, Suffredini AF, Eichacker PQ, Munford RS. Risks and benefits of activated protein C treatment for severe sepsis. New Engl J Med 2002; 347: 10271030.
Manns BJ, Lee H, Doig CJ, Johnson D, Donaldson C. An economic evaluation of activated protein C for severe sepsis. New Engl J Med 2002; 347: 9931000.
Siegel JP. Assessing the use of activated protein C in the treatment of severe sepsis. New Engl J Med 2002; 347: 10301034.
Levi M, Jonge E, Poll T. Rational for restoration of physiological anticoagulant pathways in patients with sepsis and disseminated intravascular coagulation. Crit Care Med 2001; 29 (Suppl 7): S90S94.
Baudo F, Caimi TM, de Cataldo F, et al. Antithrombin III (ATIII) replacement therapy in patients with sepsis and/or postsurgical complications: a controlled double-blind, randomised, multicenter study. Intens Care Med 1998; 24: 336342.
Eisele B, Lamy M, Thijs LG, et al. Antithrombin III in patients with severe sepsis: a randomised, placebo-controlled, double-blind multicenter trial plusa meta-analysis on all randomised, placebo-controlled, double-blind trials with antithrombin III in severe sepsis. Intens Care Med 1998; 24: 663672.
Bregengard C, Nordfang O, Wildoose P, Svendsen O, Hedner U, Diness V. The effect of two-domain tissue factor pathway inhibitor on endotoxin-induced disseminated intravascular coagulation in rabbits. Blood Coagul Fibrin 1993; 4: 699706.
Elsayed YA, Nakagawa K, Kamikubo YI, Enjyoji KI, Kato H, Sueishi K. Effects of recombinant human tissue factor pathway inhibitor on thrombus formation and its in vivo distribution in a rat DIC model. Am J Clin Pathol 1996; 106: 574583.
Inthorn D, Hoffman JN, Hartl WH, et al. Antithrombin III supplementation in severe sepsis: beneficial effects on organ dysfunction. Shock 1997; 8: 328334.
Van de Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. New Engl J Med 2001; 345: 13591367.
Go F, Gao E, Yue TL, et al. Nitric oxide mediates the antiapoptotic effect of insulin in myocardial ischemia–reperfusion: the roles of PI3-kinase, Akt, and endothelial nitric oxide synthase phosphorylation. Circulation 2002; 105: 14971502.
Mutunga M, Fulton B, Bullock R, et al. Circulating endothelial cells in patients with septic shock. Am J Respir Crit Care Med 2001; 163: 195200.
Baudouin S. Sepsis therapies: options for the future: endothelial cell replacement.Program and Abstracts of the 23rd International Symposium on Intensive Care and Emergency Medicine;March 18–21, 2003, Brussels, Belgium.
Oberholzer C, Oberholzer A, Clare-Salzler M, Moldawer LL. Apoptosis in sepsis: a new target for therapeutic intervention. FASEB J 2001; 15: 879892.
Oberholzer C, Oberholzer A, Bahjat FR, et al. Targeted adenovirus-induced expression of IL-10 decreases thymic apoptosis and improves survival in murine sepsis. Proc Natl Acad Sci USA 2001; 98: 1150311508.
Hotchkiss RS, Tinsley KW, Swanson PE, et al. Prevention of lymphocyte cell death in sepsis improves survival in mice. Proc Natl Acad Sci USA 1999; 96: 1454114546.
Hotchkiss RS, Chang KC, Swanson PE, et al. Caspace inhibitors improve survival in sepsis; a critical role of the lymphocyte. Nat Immunol 2000; 1: 496501.
Coopersmith C, Stromberg PR, Dunne WM, et al. Inhibition of intestinal epithelial apoptosis and survival in a murine model of pneumonia-induced sepsis. JAMA 2002; 287: 17161721.
Anel RL, Kumar A. Experimental and emerging therapies for sepsis and septic shock. Expert Opin Investig Drugs 2001; 10: 14711485.
Herndon DN, Ramzy PI, DebRoy MA, et al. Muscle protein catabolism after severe burn: effects of IGF-1/IGFBP-3 treatment. Ann Surg 1999; 229: 713719.
Sakurai Y, Aarsland A, Herndon DN, et al. Stimulation of muscle protein synthesis by long-term insulin infusion in severely burned patients. Ann Surg 1995; 222: 283294.
Ziegler TR, Gatzen C, Wilmore DW. Strategies for attenuating protein-catabolic responses in the critically ill. Ann Rev Med 1994; 45: 459464.
Wilmore DW. The effect of glutamine supplementation in patients following elective surgery and accidental injury. J Nutr 2001; 131 (Suppl 9): S2543S2551.
Zaloga GB, Roberts P. Permissive underfeeding. New Horiz 1994; 2: 257263.
Hotchkiss RS, Tinsley KW, Swanson PE, et al. Sepsis-induced apoptosis causes progressive profound depletion of B and CD4+ lymphocytes in humans. J Immunol 2001; 166: 69526963.
Zeni F, Freeman BF, Natanson C. Antiinflammatory therapies to treat sepsis and septic shock: a reassessment. Crit Care Med 1997; 25: 10951100.
Oberholzer A, Oberholzer C, Moldawer LL. Sepsis syndromes; understanding the role of innate and acquired immunity. Shock 2001; 16: 8396.
Docke WD, Randow F, Syrbe U, et al. Monocyte deactivation in septic patients: restoration by IFN-gamma treatment. Nat Med 1997; 3: 678681.
O'Suilleabhain C, O'Sullivan ST, Kelly JL, Ledered J, Mannick JA, Rodrick ML. Interleukin-12 treatment restores normal resistance to bacterial challenge after burn injury. Surgery 1996; 120: 290296.
Caladra T, Echtenacher B, Roy DL, et al. Protection from septic shock by neutralization of macrophage migration inhibitory factor. Nat Med 2000; 6: 164170.
Werdan K. Pathophysiology of septic shock and multiple organ dysfunction syndrome and various therapeutic approaches with special emphasis on immunoglobulins. Ther Apher 2001; 5: 115122.
Werdan K. Supplemental immune globulins in sepsis. Clin Chem Lab Med 1999; 37: 341349.
Pilz G, Fateh-Moghadam S, Viell B, et al. Supplemental immunoglobulin therapy in sepsis and septic shock. Theor Surg 1993; 8: 6183.
Pilz G, Fraunberger P, Appel R, et al. Early prediction of outcome in score-identified, postcardiac patients at high risk for sepsis, using soluble tumor necrosis factor receptor-p55 concentrations. Crit Care Med 1996; 24: 596600.
Pilz G, Appel R, Kreuzer E, Werdan K. Comparison of early IgM-enriched immunoglobulin vs polyvalent IgG administration in score-identified post-cardiac surgical patients at high-risk for sepsis. Chest 1997; 111: 419426.

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Management of septic shock: current concepts, with a particular emphasis on the role of source control, and future perspectives

  • A. G. Tsiotou (a1) and G. H. Sakorafas (a2)

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