Immunomodulation in Sepsis
Immunomodulation in Sepsis
It is beyond any doubt that sepsis is accompanied by considerable mortality and that management cannot solely rely on the single administration of antimicrobial agents. Application of immunomodulation strategies in clinical practice requires in-depth knowledge of the pathogenesis cascade of sepsis that it is far more complex than the usually applied simplistic schemes (Figure 1). Despite its simplicity, Figure 1 clearly reveals that appropriate immunomodulation requires correct knowledge of the stage at which every patient is situated.
It is an optimistic development that some of the tested regimens for immunomodulation have reached the current international guidelines of the Surviving Sepsis Campaign, such as tight glucose control, low-dose steroid replacement and administration of rhaPC in patients at a high risk of death and multiple organ failure. In any case, the fact that adequate treatment in our era still relies on prompt initial resuscitation and early administration of appropriate antibiotics, as well as on the control of the infectious site, should not be ignored.
Conclusion
It is beyond any doubt that sepsis is accompanied by considerable mortality and that management cannot solely rely on the single administration of antimicrobial agents. Application of immunomodulation strategies in clinical practice requires in-depth knowledge of the pathogenesis cascade of sepsis that it is far more complex than the usually applied simplistic schemes (Figure 1). Despite its simplicity, Figure 1 clearly reveals that appropriate immunomodulation requires correct knowledge of the stage at which every patient is situated.
It is an optimistic development that some of the tested regimens for immunomodulation have reached the current international guidelines of the Surviving Sepsis Campaign, such as tight glucose control, low-dose steroid replacement and administration of rhaPC in patients at a high risk of death and multiple organ failure. In any case, the fact that adequate treatment in our era still relies on prompt initial resuscitation and early administration of appropriate antibiotics, as well as on the control of the infectious site, should not be ignored.