Septicaemia--the clinical diagnosis

The production and consequences of the components of the state defined as 'clinically significant sepsis', as seen in patients undergoing intensive therapy--fever, shock, respiratory failure and multiple system failure--are complex. The syndrome is not necessarily accompanied by detectable bacteraemia; the effective management cannot wait upon positive blood cultures. Possibilities for more effective intervention include the use of monoclonal antibodies to endotoxin or to tumour necrosis factor, and of prostaglandins to alter the microcirculation. More refined definition of the severe sepsis syndrome will be required before these measures can be fully evaluated.