Clinical trials in sepsis

Abstract

Sepsis is increasingly common in hospitalised patients, with a mortality exceeding 40%. Patients with severe sepsis occupy approximately 45% of all critical care bed days in the UK. Activation of the innate immune system, achieved by microbial pattern recognition receptors called Toll-like receptors, is a key step in the initiation of the sepsis syndrome. Early, goal directed resuscitation of patients with severe sepsis improves outcome. The stress-induced cortisol response is frequently abnormal in sepsis; low-dose 'physiological' steroid replacement is likely to improve outcome. Treatment with recombinant activated protein C, a natural anticoagulant and anti-inflammatory agent, improves survival in severe sepsis. Outcome in sepsis can be improved by the adoption of protocolised care, as reflected in the recently published Surviving Sepsis Campaign guidelines.