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Minerva Anestesiologica 1999 July-August;65(7-8):529-40

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Sepsis and organ dysfunction/failure. An overview

Gullo A.

Department of Anaesthesia and Intensive Care, University School of Medicine, Trieste, Italy


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Sepsis is a con­di­tion at ­high ­risk for the ­patients to devel­op ­organ(s) or ­system dys­func­tion/fail­ure and rep­re­sent a ­very lim­it­ing pro­cess for sur­vi­val. Researchers and cli­ni­cians pro­posed stan­dard­iza­tion of ter­mi­nol­o­gy for sep­sis and relat­ed prob­lems to ­improve com­mu­ni­ca­tion and to eval­u­ate the effi­ca­cy of pre­ven­tive meas­ures and ther­a­peu­tic inter­ven­tions. Interrela-tion­ship ­among system­ic inflam­ma­to­ry ­response syn­drome (­SIRS), infec­tion and sep­sis are sor­round­ed by non infec­tious sat­el­lite ­events ­such as trau­ma, ­burns, pan­crea­titis, haem­or­rhag­ic ­shock, ­immune-medi­at­ed ­organ inju­ry and infec­tious ­cause ­such as fun­ge­mia, par­a­si­te­mia, vire­mia. The prev­a­lence of infec­tions ­among inten­sive ­care ­patients has ­been report­ed to ­vary ­from 15 to 40%. Usually indi­ca­tors of sep­sis are per­sis­tent hyper­lac­ta­te­mia and supra­nor­mal lev­el of DO2. These con­di­tions may ­progress as a ­sort of dynam­ic pro­cess ­known as endo­tox­ae­mia con­di­tion ­which is medi­at­ed by derange­ment of bio­hu­mo­ral fac­tors induc­ing immu­no­log­i­cal dis­so­nance and ulti­mate­ly con­com­i­tant or sequen­tial ­organs dys­func­tion/fail­ure. Multiple sourc­es of sep­sis is a phe­nom­e­non clear­ly asso­ciat­ed ­with ­poor prog­no­sis and all the sep­sis ­trials man­aged in the ­last ­decades ­have ­failed on reduc­ing mor­tal­ity ­rate in ­enrolled ­patients. Develop-ment of scor­ing ­system rou­tine­ly ­used at bed­side rep­re­sent an impor­tant meth­od to exstab­lish ­cost-effec­tive­ness in ­this exit­ing ­area of ­study and clin­i­cal man­age­ment. Controversial ­results on sep­sis ­need a ­sort of con­sen­sus at dif­fer­ent lev­el ­from research­ers to cli­ni­cian expe­ri­enc­ing new strat­e­gies for pre­ven­tion and ­more appro­pri­ate­ly ther­a­peu­tic ­approach for the man­age­ment of ­this syn­drome.

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