REVIEWS   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2000 October;159(5):165-70

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: Italian

Treatment of septic shock. Review

Maculotti L.

Azienda Ospedaliera Ospedale Niguarda Ca’ Granda - Milano, Divisione di Chirurgia Generale Andrea Ponti

The author reviews the literature that has appeared over the last ten years in order to evaluate the state-of-the-art of septic shock treatment and its future prospects. The mainstay of septic shock treatment is fluid resuscitation using a filling pressure of 12 mmHg and appropriate antibiotic treatment. Colloid solutions are preferable to crystalloid solutions and noradrenaline and dolbutamine to dopamine. Antibiotics must be administered promp-tly, even when used in association and at high doses, in relation to distribution volume for 3-4 weeks or more. Clinical trials are now being carried out with endotoxin agents, like polymixine B, HA-1A monoclonal antibody, E5 murine antibody, TNF alpha antibodies, IL-antagonist receptors and polyvalent immunoglobulins at a dose of 0.4-0.5 g/kg in 3 administrations. Hydrocortisone and vasopressin appear to be effective.
The simultaneously and appropriate administration of fluid and antibiotics results in a survival rate of 43%, although this falls to 13% if they are used separately. Noradrenaline achie-ves a better response than dopamine, by 93% compared to 31%. Dolbutamine increases cardiac output. Monoclonal antibodies significantly reduce mortality, although final results are not yet available. The same is true of polyvalent immunoglobulins.
The complex treatment of septic shock includes the administration of fluids, catecholamines and antibiotics, while future prospects point to the use of monoclonal antibodies and polyvalent immunoglobulins.