Severe Sepsis and Septic Shock

作者：Derek C. Angus, Tom van der Poll · 发表于：New England Journal of Medicine · 年份：2013 · DOI：10.1056/nejmra1208623 · 被引用次数：4036 · 研究领域：Sepsis Diagnosis and Treatment、Intensive Care Unit Cognitive Disorders、Respiratory Support and Mechanisms

epsis is one of the oldest and most elusive syndromes in medicine.Hippocrates claimed that sepsis (σ ήψις) was the process by which flesh rots, swamps generate foul airs, and wounds fester. 1 Galen later considered sepsis a laudable event, necessary for wound healing. 2 With the confirmation of germ theory by Semmelweis, Pasteur, and others, sepsis was recast as a systemic infection, often described as "blood poisoning," and assumed to be the result of the host's invasion by pathogenic organisms that then spread in the bloodstream.However, with the advent of modern antibiotics, germ theory did not fully explain the pathogenesis of sepsis: many patients with sepsis died despite successful eradication of the inciting pathogen.Thus, researchers suggested that it was the host, not the germ, that drove the pathogenesis of sepsis.3 In 1992, an international consensus panel defined sepsis as a systemic inflammatory response to infection, noting that sepsis could arise in response to multiple infectious causes and that septicemia was neither a necessary condition nor a helpful term.4 Instead, the panel proposed the term "severe sepsis" to describe instances in which sepsis is complicated by acute organ dysfunction, and they codified "septic shock" as sepsis complicated by either hypotension that is refractory to fluid resuscitation or by hyperlactatemia.In 2003, a second consensus panel endorsed most of these concepts, with the caveat that signs of a systemic inflammatory response, s...