Related Experiment Videos
[Supportive sepsis therapy: what is still valid today?]
1Chirurgische Klinik und Poliklinik, Klinikum Grosshadern, Marchioninistrasse 15, 81377 München.
Insights
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.
Abstract:
Following several disappointing approaches to decrease the mortality of septic patients using various adjuncts, protein C is the first substance leading to a significant reduction of the mortality rate (PROWESS). The increased risk for bleeding complications in patients receiving protein C, however, limits its use in septic surgical patients. Administration of AT III in septic patients (KYBERSEPT) reduced the mortality rate solely in patients which were not treated with heparin. Although hydrocortisone reduced the amount of vasoactive katecholamines the effect of hydrocortisone administration on the survival rate remains unknown. In summary, early intervention to eliminate the septic focus and the use of antibiotics according to an antibiogramm still remains the most efficient basis for the treatment of septic patients.