J Anesth Perioper Med. 2015;2(1):36-44. https://doi.org/10.24015/ebcmed.japm.2015.0006
From the 1Department of Anesthesiology, Chang Gung Memorial Hospital, Taiwan, China; 2Department of Physiology, College of Medicine, Chang Gung University, Taiwan, China; 3College of Medicine, Chang Gung University, Taiwan, China.
Correspondence to Dr. Huang-Ping Yu at firstname.lastname@example.org.
EBCMED ID: ebcmed.japm.2015.0006 DOI: 10.24015/ebcmed.japm.2015.0006
Aim of review
Trauma, shock and sepsis are often associated with multiple organ failure. Despite the progress made in patient management over the last decade, sepsis and subsequent multiple organ failure continue to be the major cause of morbidity and mortality in injured patients.
We reviewed the current information on the multiple organ dysfunction and use of therapeutic apheresis procedures as adjunctive therapy in such clinical situations as well as the exciting prospects for the near future.
Most of clinical trials have failed to demonstrate any outcome benefit. However, corticosteroids, anti-endotoxin antibodies, anti-tumor necrosis factor-α antibody, interleukin (IL)- 1β receptor antagonist and recombinant activated protein C are to date the possible drugs that may demonstrate mortality benefits in large randomized controlled trials. This could be attributed to their broad based attempts at modulating the inflammatory response to infection.
Basic research with related pathophysiologic approaches has driven clinical trials using molecules that might interfere with inflammatory processes. Against inflammatory response, the time to initiate therapy is thought to be crucial and the major determinant factor in surviving trauma, shock and sepsis. Despite substantial progress in trauma, shock and sepsis therapy, the important strategies between the discovery of new effective medical molecules and their implementation in the daily clinical practice of the intensive care unit remain a major hurdle. Fortunately, ongoing research continues to provide new information on the management of trauma, shock and sepsis. On this basis, new therapies could be tested to reduce mortality rates in trauma, shock and sepsis with respect to recently published studies.
Declaration of Interests
The authors declare that there is no conflict of interests regarding the publication of this paper.
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