Author/Editor		Jereb, Matjaž; Trampuž, Andrej
Title		Novosti v patogenezi in zdravljenju sepse
Translated title		New developments in the pathogenesis and treatment of sepsis
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 72, št. 12
Publication year		2003
Volume		str. 675-80
Language		slo
Abstract		Background. Severe sepsis a nd septic shock a re the most important causes of death in patients in intensive care units. In the last decades the incidence of sepsis increased and the case fatality rate of septic shock did not decreased significantly despite improved intensive care medicine. Clinical presentations of severe sepsis and septic shock are predominantly a result of dysregulation of the immune system caused by parts of the bacterial cell wall, endotoxins and exotoxins. Inflammatory cascade and cytokines plays an important role in the pathogenesis of sepsis. Conclusions. Early and appropriate antimicrobial treatment as well as surgical removal of an septic focus improve the survival of patients with sepsis. In the past, various immunomodulatory therapies (antiendotoxins, antimediator interventions and immunostimulation therapy) did not decreased the mortality of patients with sepsis. In the last years, however, some interventions in selected patients with severe sepsis and septic shock have shown significantly improved survival These interventions include treatment with activated protein C, early goal-directed therapy, intensive treatment with insulin, low-dose corticosteroid treatment and use of low tidal volumes in patients with acute lung injury or acute respiratory distress syndrome. In this article new developments in pathogenesis and therapy of sepsis are reviewed.
Summary		Izhodišča. Huda sepsa in septični šok predstavljata najpomembnejši vzrok smrtnosti pri bolnikih na intenzivnih oddelkih. Pojavnost sepse se je v zadnjih desetletjih povečala, smrtnost septičnega šoka pa se navkljub napredku intenzivne medicine v zadnjih 25 letih ni bistveno zmanjšala. Klinična slika težke sepse in septičnega šoka je pretežno posledica motene regulacije imunskega sistema, ki jo sprožijo sestavine bakterijske celične stene, endotoksini in eksotoksini. Vnetna kaskada in citokini igrajo pomembno vlogo v patogenezi sepse. Zaključki. Zgodnje in ustrezno protimikrobno zdravljenje ter sanacija žarišča okužbe izboljšata preživetje bolnikov s sepso. Zdravljenje z različnimi imunomodulacijskimi učinkovinami (antiendotoksini, antimediacijske učinkovine in stimulatorji imunskega sistema) v preteklosti ni pomembno znižalo smrtnosti bolnikov s sepso. V zadnjih letih so kljub temu novosti pri obravnavanju bolnikov s sepso. Zdravljenje z aktiviranim proteinom C, zgodnja hemodinamska podpora, intenzivno zdravljenje z inzulinom, nizki odmerki kortikosteroidov in majhen dihalni volumen pri akutni okvari pljuč ali sindromu akutne dihalne stiske lahko pomembno izboljšajo preživetje bolnikov s težko sepso ali septičnim šokom. V članku so pregledno prikazane novosti v patogenezi in zdravljenju sepse.
Descriptors		SEPSIS SHOCK, SEPTIC INTENSIVE CARE UNITS SEPSIS SYNDROME PROTEIN C INSULIN INFLAMMATION MEDIATORS MULTIPLE ORGAN FAILURE IMMUNOSUPPRESSION ANTIBIOTICS ANTI-INFLAMMATORY AGENTS, STEROIDAL