Management of Septic Shock: Present and Future

Editorials15 September 1991Management of Septic Shock: Present and FutureJoseph E. Parrillo, MDJoseph E. Parrillo, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-115-6-491 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptSepsis and septic shock have been increasing in incidence for the last 60 years, and sepsis is presently the most common cause of death in intensive care units in the United States. Reasonable current estimates of annual incidence are 400 000 bouts of sepsis, 200 000 cases of septic shock, and 100 000 deaths from this disease (1). The reasons for this rising incidence include increased use of invasive devices such as intravascular and bladder catheters, more frequent corticosteroid and cytotoxic therapy, and enhanced longevity of patients (for example, patients with diabetes) who are susceptible to sepsis.The overall mortality...References1. ParrilloParkerNatansonSuffrediniDannerCunnlon JMCARR. NIH Conference. Septic shock in humans: advances in the understanding of pathogenesis, cardiovascular dysfunction, and therapy. Ann Intern Med. 1990:113:227-42. LinkGoogle Scholar2. Bone R. Sepsis, the sepsis syndrome, multi-organ failure: a plea for comparable definitions [Editorial]. Ann Intern Med. 1991:114:332-3. LinkGoogle Scholar3. Bone R. The pathogenesis of sepsis. Ann Intern Med. 1991;115:457-69. LinkGoogle Scholar4. AustrianGold RJ. Pneumococcal bacteremia with special reference to bacteremic pneumococcal pneumonia. Ann Intern Med. 1964;60:759-76. LinkGoogle Scholar5. KregerCravenMcCabe BDW. Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med. 1980;68:344-55. CrossrefMedlineGoogle Scholar6. BryanReynoldsBrenner CKE. Analysis of 1,186 episodes of gram-negative bacteremia in non-university hospitals: the effects of antimicrobial therapy. Rev Infect Dis. 1983;5:629-38. CrossrefMedlineGoogle Scholar7. LiPhillipsShawCookNatansonGoldman TMLECL. On-site physician staffing in a community hospital intensive care unit. Impact on test and procedure use and on patient outcome. JAMA. 1984;252:2023-7. CrossrefMedlineGoogle Scholar8. ReynoldsHauptThill-BaharozianCarlson HMMR. Impact of critical care physician staffing on patients with septic shock in a university hospital medical intensive care unit. JAMA. 1988;260:3446-50. CrossrefMedlineGoogle Scholar9. NatansonDannerReillyDoerflerHoffmanAkin CRJMWG. Antibiotics versus cardiovascular support in a canine model of human septic shock. Am J Physiol. 1990;259 (5 Pt. 2):H1440-7. MedlineGoogle Scholar10. SprungCaralisMarcialPierceGelbardLong CPEMMW. The effects of high-dose corticosteroids in patients with septic shock. A prospective, controlled study. N Engl J Med. 1984;311:1137-43. CrossrefMedlineGoogle Scholar11. BoneFisherClemmerSlotmanMetzBalk RCTGCR. A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med. 1987;317:653-8. CrossrefMedlineGoogle Scholar12. Effect of high-dose glucocorticoid therapy on mortality in patients with clinical signs of systemic sepsis. The Veterans Administration Systemic Sepsis Cooperative Study Group. N Engl J Med. 1987;317:659-65. CrossrefMedlineGoogle Scholar13. SuffrediniFrommParkerBrennerKovacsWesley ARMMJR. The cardiovascular response of normal humans to the administration of endotoxin. N Engl J Med. 1989;321:280-7. CrossrefMedlineGoogle Scholar14. ZieglerMcCutchanFiererGlauserSadoffDouglas EJJMJH. Treatment of gram-negative bacteremia and shock with human antiserum to a mutant Escherichia coli. N Engl J Med. 1982;307:1225-30. CrossrefMedlineGoogle Scholar15. BaumgartnerGlauserMcCutchanZieglervan MelleKlauber JMJEGM. Prevention of gram-negative shock and death in surgical patients by antibody to endotoxin core glycolipid. Lancet. 1985;2:59-63. CrossrefMedlineGoogle Scholar16. CalandraGlauserSchellekensVerhoef TMJJ. Treatment of gram-negative septic shock with human IgG antibody to Escherichia coli J5: a prospective, double-blind, randomized trial. J Infect Dis. 1988;158:312-9. CrossrefMedlineGoogle Scholar17. GorelickScannonHannigenWedelAckerman KPJNS. Randomized placebo-controlled study of E5 monoclonal anti-endotoxin antibody. In: Borrebaeck CA, Larrick JW, eds. Therapeutic Monoclonal Antibodies. New York: Stockton Press; 1990;253-61. CrossrefGoogle Scholar18. ZieglerFisherSprungStraubeSadoffFoulke ECCRJG. Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin. A randomized, double-blind, placebo-controlled trial. N Engl J Med. 1991;324:429-36. CrossrefMedlineGoogle Scholar19. DannerJoinerParrillo RKJ. Inhibition of endotoxin-induced priming of human neutrophils by lipid X and 3-Aza-lipid X. J Clin Invest. 1987;80:605-12. CrossrefMedlineGoogle Scholar20. OhlssonBjorkBergenfeldtHagemanThompson KPMRR. Interleukin-1 receptor antagonist reduces mortality from endotoxin shock. Nature. 1990;348:550-2. CrossrefMedlineGoogle Scholar21. EngelmannAderkaRubinsteinRotmanWallach HDMDD. A tumor necrosis factor-binding protein purified to homogeneity from human urine protects cells from tumor necrosis factor toxicity. J Biol Chem. 1989:264:11974-80. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Joseph E. Parrillo, MDAffiliations: Rush-Presbyterian-St. Luke's Medical Center Chicago, IL 60612 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byExtracorporeal cytokine elimination as rescue therapy in refractory septic shock: a prospective single-center studyCombined immunomodulator and antimicrobial therapy eliminates polymicrobial sepsis and modulates cytokine production in combined injured miceHemodynamic Monitoring in SepsisHemodynamic Monitoring in SepsisPrompt antibiotic administration and goal-directed hemodynamic support in patients with severe sepsis and septic shockVasopressin During Cardiopulmonary Resuscitation and Different Shock StatesSystemic inflammatory response syndromeEfficacy and safety of LY315920Na/S-5920, a selective inhibitor of 14-kDa group IIA secretory phospholipase A2, in patients with suspected sepsis and organ failureMulticenter evaluation of a human monoclonal antibody to Entero-bacteriaceae common antigen in patients with Gram-negative sepsisCytokine modulation in sepsis and septic shockBacterial Toxins Induce Selective Cytokine Patterns In Vivo and In VitroRandomized, placebo-controlled trial of the anti-tumor necrosis factor antibody fragment afelimomab in hyperinflammatory response during severe sepsis: The RAMSES StudyA Novel Receptor Tyrosine Kinase, Mer, Inhibits TNF-α Production and Lipopolysaccharide-Induced Endotoxic ShockChylomicrons alter the hepatic distribution and cellular response to endotoxin in ratsProstaglandin I2Analogue, Iloprost, Down Regulates Mitogen-Activated Protein Kinases of MacrophagesDouble-blind randomised controlled trial of monoclonal antibody to human tumour necrosis factor in treatment of septic shockEndogenous Mediators in Sepsis and Septic ShockCurrent Status of Clinical Trials With Anti-TNFThe level of lipopolysaccharide-binding protein is significantly increased in plasma in patients with the systemic inflammatory response syndromeRole of Cytokines in SepsisExhaled nitric oxide as a marker for serum nitric oxide concentration in acute endotoxemiaInflammatory mediators in sepsis: rationale for extracorporeal therapies?Prostaglandin E sub 2 Production by Endotoxin-Stimulated Alveolar Macrophages Is Regulated by Phospholipase C PathwaysSepsis in the ElderlyADJUNCTS TO ANTIBACTERIAL THERAPYThe Systemic Inflammatory Response, Sepsis, and Multiple Organ Dysfunction: New Definitions for an Old ProblemMediator-Specific Therapies for the Systemic Inflammatory Response Syndrome, Sepsis, Severe Sepsis, and Septic Shock: Present and Future ApproachesPulmonary infiltrations in febrile patients with neutropenia. Risk factors and outcome under empirical antimicrobial therapy in a randomized multicenter studyBiologicals and Hematopoietic Cytokines in Prevention or Treatment of Infections in Immunocompromised HostsAntiendotoxin Therapy in SepsisPathogenetic Mechanisms of Septic ShockPharmacologic Cardiovascular SupportSeptic Shock Pathophysiology: Focus on Therapeutic ApproachC1-inhibitor substitution therapy in septic shock and in the vascular leak syndrome induced by high doses of interleukin-2Soft Tissue InfectionsMore on pathogenesis and treatment of septic shockInterplay of complement and cytokines in the pathogenesis of septic shock 15 September 1991Volume 115, Issue 6Page: 491-493KeywordsBladderCathetersCorticosteroid therapyCritical careForecastingIntensive care unitsInterleukinsMortalitySepsisShock ePublished: 1 December 2008 Issue Published: 15 September 1991 PDF downloadLoading ...