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Septic shock; current pathogenetic concepts from a clinical perspective

Adelais G Tsiotou, George H. Sakorafas, George Anagnostopoulos, John Bramis

Med Sci Monit 2005; 11(3): RA76-85

ID: 15400

Sepsis is an infection-induced syndrome characterized by a generalized infl ammatory state and represents a frequent complication in the surgical patient. The normal reaction to infection involves a series of complex immunologic processes. A potent, complex immunologic cascade ensures a prompt protective response to microbial invasion in humans. Although activation of the immune
system during microbial invasion is generally protective, septic shock develops in a number of patients as a consequence of excessive or poorly regulated immune response to the offending organism
(Gram-negative or Gram-positive bacteria, fungi, viruses, or microbial toxins). This unbalanced reaction may harm the host through a maladaptive release of endogenously generated infl ammatory
compounds. Many mechanisms are involved in the pathogenesis of septic shock, including the release of cytokines, the activation of neutrophils, monocytes, and microvascular endothelial cells,
as well as the activation of neuroendocrine refl exes and plasma protein cascade systems, such as the complement system, the intrinsic (contact system) and extrinsic pathways of coagulation, and
the fi brinolytic system. In critically ill patients, the gastrointestinal tract plays a central role in the pathogenesis of septic shock. The potential for complementary and synergistic interaction of the
different components in this cascade highlights the diffi culty encountered in trying to identify a single means of altering the progression of sepsis and septic shock to multiple organ dysfunction
syndrome (MODS) and multiple organ failure (MOF).

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