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[Supportive sepsis therapy: what is still valid today?].
1Chirurgische Klinik und Poliklinik, Klinikum Grosshadern, Marchioninistrasse 15, 81377 München.
Kongressband. Deutsche Gesellschaft Fur Chirurgie. Kongress
|February 5, 2002
Summary
Despite new treatments, early source control and antibiotics remain key for septic patients. Protein C reduces mortality but increases bleeding risk, while AT III benefits only those not on heparin.
Area of Science:
- Critical care medicine
- Pharmacology
- Infectious diseases
Context:
- Sepsis management has seen limited success with various adjuncts.
- Protein C (PROWESS) demonstrated significant mortality reduction in septic patients.
- Bleeding complications associated with protein C restrict its use in surgical sepsis.
Purpose:
- To review the efficacy and limitations of adjunct therapies in sepsis treatment.
- To evaluate the impact of Protein C, AT III, and hydrocortisone on sepsis mortality.
- To emphasize the foundational role of source control and antibiotic therapy.
Summary:
- Protein C therapy (PROWESS) is the first adjunct to significantly lower sepsis mortality.
- Antithrombin III (AT III) showed mortality benefit only in non-heparinized patients (KYBERSEPT).
- Hydrocortisone's effect on survival remains unclear, despite reducing vasoactive agents.
Impact:
- Highlights the need for risk-benefit assessment in sepsis adjuncts.
- Reinforces the established efficacy of early source control and targeted antibiotics.
- Informs clinical decisions regarding the use of Protein C and AT III in sepsis management.