Septicaemia and the prevention of multiorgan failure--the intensive care perspective

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Pathophysiology

Background:

• Septicaemia presents atypically, with tachypnoea, hypotension, and confusion as common signs.
• High mortality rates (40-80%) and significant ICU deaths (70%) highlight the severity of septicaemia.
• Despite sensitive antimicrobial drugs, patient mortality remains high due to mediator-induced organ system effects.

Purpose of the Study:

• To explore the unifying hypothesis of microvascular failure in septicaemia-induced multiple organ failure.
• To discuss the correlation between organ system failures and mortality in septicaemia.
• To outline current supportive management strategies focused on preventing organ failure.

Main Methods:

• Focus on supportive management, emphasizing circulatory manipulation.
• Utilizing intravascular volume expansion, vasoactive drugs, mechanical ventilation, and invasive monitoring.
• Employing a 'best guess' antimicrobial approach with multiple agents pending organism isolation.

Main Results:

• Microvascular failure causing tissue hypoxia is proposed as the unifying mechanism for multiple organ failure.
• Mortality is directly correlated with the number of organ systems failing.
• Aggressive surgical drainage or excision is crucial for abdominal sepsis.

Conclusions:

• Supportive management, particularly circulatory support, is central to preventing organ failure in septicaemia.
• Antimicrobial therapy requires a pragmatic 'best guess' strategy initially.
• Experimental adjunctive therapies targeting sepsis mediators show potential but require further investigation.