Will This Be the Holy Grail for Sepsis?

Hello. I'm Paul Auwaerter for Medscape Infectious Diseases, speaking from the Johns Hopkins School of Medicine.

As I just finished rounding in our ICU, seeing critically ill patients reminded me that incremental progress had been made in sepsis, but we remain desperate to help our patients who are profoundly ill despite supportive care and appropriate antimicrobial therapy.

Approaches to severe sepsis and septic shock continue to evolve with strategies put forward and discarded regularly. The focus for distributive shock is now on timely fluid resuscitation, antibiotics, and, if necessary, vasopressor agents. However, the holy grail seems to have always been to intervene in the inflammatory cascade, shutting down what is often a deleterious set of forces that contribute to death. Complicating factors have been that sepsis is such a heterogeneous condition, not only in the infectious causes but in the host immune responses, yet all randomized clinical trials use a very firm endpoint: mortality.

There is a veritable graveyard of interventions that have never proven truly effective. Those of you who have viewed some of my videos know that I like looking back as well as forward. I remember as a house officer and infectious diseases fellow in the 1980s and 1990s the excitement and promise of antibody-based interventions led by Elizabeth Ziegler