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Sepsis and Innovative Treatment: The Odyssey R. C. Bone The Odyssey by Homer, dates back to the 8th century, B. C. [1]. It is a great epic adventure of Odysseus's dramatic journey from Troy back home to Ithaca. Odysseus survives the ordeals of this journey and returns with new powers and insights. The study of the pathogenesis and treatment of sepsis has also been an odys sey. I feel we will return from this odyssey with new insights and treatments. However, as with Odysseus, this will occur only after considerable struggle. In the 1980s we had a rather simplistic view of sepsis. It was a highly lethal complication caused by infection and often charac terized by shock and multi-organ failure. Our knowledge of the inflammatory responses associated with sepsis was embryonic compared to today. The inflammatory response was often treat ment with mega-dose corticosteroids along with fluid resuscita tion, vasopressors and antibiotics. Because of the paucity of mul ti-center controlled trials documenting the risk/benefit ratio of the treatment of sepsis with corticosteroids, two large multi-cen ter controlled trials were organized to evaluate the role of corti costeroids in sepsis [2, 3]. Because animal models showed bene fits of corticosteroids only with pre-treatment or early treatment, a definition of sepsis was used that did not require positive cul ture documentation or septic shock to be included in the studied population.
List of contents
Epidemiology of Sepsis.- The Systemic Inflammatory Response Syndrome (SIRS).- The "At Risk" Patient Population.- Outcome and Prognostic Factors in Bacteremic Sepsis.- ARDS and Sepsis: Resemblances and Differences.- Monitoring the Treatment of Sepsis.- Microbiological Requirements for Studies of Sepsis.- Measurement of Inflammatory Mediators in Clinical Sepsis.- Whole Body and Organ Measures of 02 Availability.- Multiple Organ Dysfunction Syndrome (MODS).- Monitoring Illness Severity.- What Determines Prognosis in Sepsis?.- SAPS II and MPM II Models for Early Severe Sepsis.- Clinical Management of Sepsis.- Fluid Therapy in Septic Shock.- Role of RBC Transfusion Therapy in Sepsis.- Vasoactive Drug Therapy in Sepsis.- Evidence-Based Analysis of Nutrition Support in Sepsis.- Investigational Therapy of Sepsis.- Anti-Endotoxin Therapy.- Critical Reappraisal of Steroids and Other Anti-Inflammatory Agents.- Investigational Therapy of Sepsis: Anti-TNF, IL-1ra, Anti-PAF and G-CSF.- Sepsis and Acute Lung Injury.- Increasing Oxygen Delivery in Sepsis.- Designing the Optimum Clinical Trial for the Treatment of Sepsis.- Critical Evaluation of the Design and Conduct of Previous Clinical Trials in Sepsis.- Evaluation of the Adequacy of Source Control.- Statistical Considerations for the Design of the Optimal Clinical Trial.- The Monitoring and Reporting of Clinical Trials.- Economic Evaluation in the Critical Care Literature.- Ethical Issues in Clinical Trials.
