Multiple organ dysfunction complicating sepsis remains
the commonest cause of mortality in the ICU. However,
its mechanisms remain unknown, and the results of
pathological autopsy studies show no correlation with
degree of organ dysfunction or with specific causes of
death. Nevertheless, these mechanisms continue to be
unravelled, alongside emerging genetic predisposing
targets. Moreover, the concept of a variable immune
status, which can be tracked during sepsis and modulated,
provides an increasing number of potential new
therapeutic targets. A body of evidence accrued over
decades reemphasises the fundamental importance of
early recognition of physiological surrogates of tissue
dysoxia in reducing associated organ dysfunction. Local
and International clinical strategies, through a phased
approach of the development of evidenced-based guidelines
(incorporating proven strategies in sepsis), their
implementation and evaluation, have undertaken the
challenge of effecting improved survival in this patient
population.
Multiple organ dysfunction complicating sepsis remainsthe commonest cause of mortality in the ICU. However,its mechanisms remain unknown, and the results ofpathological autopsy studies show no correlation withdegree of organ dysfunction or with specific causes ofdeath. Nevertheless, these mechanisms continue to beunravelled, alongside emerging genetic predisposingtargets. Moreover, the concept of a variable immunestatus, which can be tracked during sepsis and modulated,provides an increasing number of potential newtherapeutic targets. A body of evidence accrued overdecades reemphasises the fundamental importance ofearly recognition of physiological surrogates of tissuedysoxia in reducing associated organ dysfunction. Localand International clinical strategies, through a phasedapproach of the development of evidenced-based guidelines(incorporating proven strategies in sepsis), theirimplementation and evaluation, have undertaken thechallenge of effecting improved survival in this patientpopulation.
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