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Minerva Anestesiologica 2003 June;69(6):539-61

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: English, Italian

Sepsis: state of the art

Gattinoni L., Vagginelli F., Taccone P., Carlesso E., Bertoja E.

Department of Anesthesiology, Ospedale Maggiore Policlinico IRCCS, Milano University of Milan, Milan, Italy

In ­recent ­years, we ­have con­sid­er­ably wid­ened our knowl­edge of the pathoph­y­sio­lo­gy of sep­sis and ­some pro­ce­dures, aim­ing ­both to ­relieve symp­toms and con­trol the inflam­ma­tion/coag­u­la­tion reac­tion, ­have prov­en to be effec­tive in increas­ing sur­vi­val. This ­improves ­when mechan­i­cal ven­ti­la­tion is ­applied ­with low ­tidal vol­umes, ­fluid replace­ment and the use of car­di­oac­tive ­drugs are titrat­ed on the oxy­gen sat­u­ra­tion of hemo­glo­bin in the cen­tral ­venous ­system and ­blood glu­cose ­does not ­exceed cer­tain lim­its. It is ­also evi­dent ­that inflam­ma­tion and coag­u­la­tion are close­ly relat­ed to ­each oth­er. The inhi­bi­tion of ­only one path­way, ­such as the inhi­bi­tion of inflam­ma­tion ­with ­high dos­age ster­oids or the inhi­bi­tion of coag­u­la­tion ­with anti­throm­bin, ­does not pro­duce a sur­vi­val improve­ment. The ­only mole­cule ­which has prov­en to be not­ably effec­tive in reduc­ing mor­tal­ity is Activated Protein C inter­act­ing on coag­u­la­tion/fib­ri­nol­y­sis, as ­well as on inflam­ma­tion pro­cess­es. Multinodal mod­ula­tion of sev­er­al inter­de­pen­dent pro­cess­es may be the prob­able rea­son for the prov­en effec­tive­ness of ­this treat­ment.