Anti-inflammatory therapies in sepsis and septic shock

2000 ◽  
Vol 9 (7) ◽  
pp. 1651-1663 ◽  
Author(s):  
Bradley D Freeman ◽  
Charles Natanson
Keyword(s):  
Septic Shock ◽  
Anti Inflammatory ◽  
Sepsis And Septic Shock

scholarly journals Cytokines in Sepsis: Potent Immunoregulators and Potential Therapeutic Targets—An Updated View

2013 ◽  
Vol 2013 ◽  
pp. 1-16 ◽  
Author(s):  
Wibke Schulte ◽  
Jürgen Bernhagen ◽  
Richard Bucala
Keyword(s):  
Septic Shock ◽  
Immune Response ◽  
Intensive Care ◽  
Defense Mechanisms ◽  
Causes Of Death ◽  
Current Knowledge ◽  
The Other ◽  
Anti Inflammatory ◽  
Pleiotropic Regulators ◽  
Sepsis And Septic Shock

Sepsis and septic shock are among the leading causes of death in intensive care units worldwide. Numerous studies on their pathophysiology have revealed an imbalance in the inflammatory network leading to tissue damage, organ failure, and ultimately, death. Cytokines are important pleiotropic regulators of the immune response, which have a crucial role in the complex pathophysiology underlying sepsis. They have both pro- and anti-inflammatory functions and are capable of coordinating effective defense mechanisms against invading pathogens. On the other hand, cytokines may dysregulate the immune response and promote tissue-damaging inflammation. In this review, we address the current knowledge of the actions of pro- and anti-inflammatory cytokines in sepsis pathophysiology as well as how these cytokines and other important immunomodulating agents may be therapeutically targeted to improve the clinical outcome of sepsis.

Anti-inflammatory therapies to treat sepsis and septic shock

1997 ◽  
Vol 25 (7) ◽  
pp. 1095-1100 ◽  
Author(s):  
Fabrice Zeni ◽  
Bradley Freeman ◽  
Charles Natanson
Keyword(s):  
Septic Shock ◽  
Anti Inflammatory ◽  
Sepsis And Septic Shock

scholarly journals A multicentre case-control study of nonsteroidal anti-inflammatory drugs as a risk factor for severe sepsis and septic shock

Critical Care ◽  
2009 ◽  
Vol 13 (2) ◽  
pp. R43 ◽  
Author(s):  
Annick Legras ◽  
Bruno Giraudeau ◽  
Annie-Pierre Jonville-Bera ◽  
Christophe Camus ◽  
Bruno François ◽  
...  
Keyword(s):  
Septic Shock ◽  
Risk Factor ◽  
Severe Sepsis ◽  
Case Control Study ◽  
Case Control ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Sepsis And Septic Shock ◽  
Control Study

Plasma Filtration Adsorption Dialysis (PFAD): A New Technology for Blood Purification

2005 ◽  
Vol 28 (7) ◽  
pp. 731-738 ◽  
Author(s):  
F. Nalesso
Keyword(s):  
Septic Shock ◽  
Critical Care ◽  
Severe Sepsis ◽  
Inflammatory Mediators ◽  
High Volume ◽  
Blood Purification ◽  
Plasma Filtration ◽  
High Volume Hemofiltration ◽  
Anti Inflammatory ◽  
Sepsis And Septic Shock

Severe sepsis is one of the most significant challenges in critical care. Despite all the developments achieved in infectious diseases and critical care, along with numerous attempts to develop treatments, the mortality rate of severe sepsis and septic shock remains unacceptably high. The pathophysiology of severe sepsis and septic shock is only partially understood. Circulating pro-inflammatory and anti-inflammatory mediators appear to participate in the complex cascade of events which leads to deranged microcirculatory function, as we know from the peak concentration hypothesis. Therapeutic trials targeting single pro-inflammatory and anti-inflammatory mediators failed to demonstrate any benefit, suggesting that the unselective removal of different mediators may be a more appropriate approach. In severe sepsis several blood purification techniques, such as continuous hemofiltration (CVVH), high volume hemofiltration (HVHF), pulse high volume hemofiltration (HVHF), plasma filtration, plasma adsorption, coupled plasma filtration adsorption (CPFA), have been proposed but such techniques appear to have both theorical as well as practical limitations. Plasma Filtration Adsorption Dialysis (PFAD) is a new extracorporeal treatment which combines different principles of blood purification in a single device. The core of this technique is a new dialyzer composed by three suitable compartments that provide specific functions. The association of multiple principles permits specific removal of molecules implicated in the pathophysiology of patient's disease and re-establishment of hydro-electrolyte, acid-base equilibrium, if renal dysfunction-failure is present. The final target of PFAD is to obtain complete purification by combining principles of physics and chemistry to remove hydrophilic and hydrophobic molecules with a very wide range of weights.

scholarly journals PERAN INFLAMASI DALAM PATOFISIOLOGI SEPSIS DAN SYOK SEPTIK PADA ANAK

2013 ◽  
Vol 1 (3) ◽  
Author(s):  
Yosef Oematan ◽  
Jeanette I. Ch. Manoppo ◽  
Ari L. Runtunuwu
Keyword(s):  
Septic Shock ◽  
T Cell ◽  
Health Workers ◽  
Multiple Organ ◽  
Host Responses ◽  
T Helper ◽  
Helper T Cell ◽  
Organ Failures ◽  
Anti Inflammatory ◽  
Sepsis And Septic Shock

Abstract: As one of the main causes of death in critically patients in intensive care unit, sepsis remains a health problem in developing and industrialized countries. Sepsis spectrum varies from invasion of microbes into the bloodstream associated with early signs of circulatory disorders (tachycardia, tachypneu, peripheral vasodilatation, fever, hypothermia) to circulatory collapse, multiple organ failures, and even death. Sepsis and septic shock occurs due to uncontrolled inflammation and immune system failure. Activated CD4 T cells are programmed to secrete mediators that have either one of two distinct and antagonistic profiles: proinflammatory [type 1 helper T-cell (Th1)] or anti-inflammatory [type 2 helper T-cell (Th2)]. There is a complex interaction between these proinflammatory and anti-inflammatory mediators in sepsis and septic shock. The balance of these two kinds of mediators helps the involved tissues in repairing and healing processes. High mortality rates of sepsis occur when/if the levels of both kinds of mediators are high. Prognosis of patients is affected by the severity of infections, previous health status, and host responses. Understanding the role of inflammation in the pathophysiology of sepsis and septic shock may improve the ability of health workers in diagnosis and handling of sepsis patients. Key words: Sepsis, septic shock, inflammation, proinflammatory and antiinflammatory mediators. Abstrak: Sebagai salah satu penyebab utama kematian terutama pada penderita di unit perawatan intensif, sepsis tetap merupakan masalah kesehatan baik di negara berkembang maupun negara maju. Spektrum sepsis bervariasi dari invasi mikroba ke aliran darah dengan tanda awal gangguan sirkulasi (takikardia, takipnu, vasodilatasi perifer, demam atau hipotermi) hingga kolaps sirkulasi, kegagalan sistem multiorgan bahkan kematian. Sepsis dan syok septik terjadi akibat tidak terkontrolnya inflamasi dan kegagalan system imun. Sel T CD4 teraktivasi menyekresi mediator yang memiliki salah satu dari dua profil yang berbeda, yakni: proinflamasi [sel T-helper tipe 1 (Th1)] atau anti-inflamasi [sel T-helper tipe 2 (Th2)]. Terdapat interaksi yang kompleks antara sejumlah mediator proinflamasi dan anti inflamasi pada sepsis dan syok septik. Keseimbangan antara kedua jenis mediator dapat membantu perbaikan dan pemulihan jaringan. Angka kematian akan tinggi bila kadar keduanya tinggi. Prognosis penderita dipengaruhi oleh beratnya infeksi, status kesehatan sebelumnya dan respon host. Dengan memahami kontribusi inflamasi dalam patofisiologi sepsis dan syok septik dapat meningkatkan kemampuan tenaga kesehatan dalam menegakkan diagnosis dan menangani penderita sepsis. Kata kunci: Sepsis, syok septik, inflamasi, mediator proinflamasi dan anti-inflamasi

Effect of fluid bolus triggers and their combination on fluid responsiveness in optimization phase of severe sepsis and septic shock resuscitation

MedPharmRes ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. 27-32
Author(s):  
Bien Le ◽  
Dai Huynh ◽  
Mai Tuan ◽  
Minh Phan ◽  
Thao Pham ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Fluid Responsiveness ◽  
Statistical Significance ◽  
Venous Pressure ◽  
Fluid Bolus ◽  
Low Blood Pressure ◽  
Low Central Venous Pressure ◽  
Sepsis And Septic Shock

Objectives: to evaluate the fluid responsiveness according to fluid bolus triggers and their combination in severe sepsis and septic shock. Design: observational study. Patients and Methods: patients with severe sepsis and septic shock who already received fluid after rescue phase of resuscitation. Fluid bolus (FB) was prescribed upon perceived hypovolemic manifestations: low central venous pressure (CVP), low blood pressure, tachycardia, low urine output (UOP), hyperlactatemia. FB was performed by Ringer lactate 500 ml/30 min and responsiveness was defined by increasing in stroke volume (SV) ≥15%. Results: 84 patients were enrolled, among them 30 responded to FB (35.7%). Demographic and hemodynamic profile before fluid bolus were similar between responders and non-responders, except CVP was lower in responders (7.3 ± 3.4 mmHg vs 9.2 ± 3.6 mmHg) (p 0.018). Fluid response in low CVP, low blood pressure, tachycardia, low UOP, hyperlactatemia were 48.6%, 47.4%, 38.5%, 37.0%, 36.8% making the odd ratio (OR) of these triggers were 2.81 (1.09-7.27), 1.60 (0.54-4.78), 1.89 (0.58-6.18), 1.15 (0.41-3.27) and 1.27 (0.46-3.53) respectively. Although CVP < 8 mmHg had a higher response rate, the association was not consistent at lower cut-offs. The combination of these triggers appeared to raise fluid response but did not reach statistical significance: 26.7% (1 trigger), 31.0% (2 triggers), 35.7% (3 triggers), 55.6% (4 triggers), 100% (5 triggers). Conclusions: fluid responsiveness was low in optimization phase of resuscitation. No fluid bolus trigger was superior to the others in term of providing a higher responsiveness, their combination did not improve fluid responsiveness as well.

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