Advances in Sepsis Treatment.

Investigations of novel sepsis treatments have proven ineffective in the past. Despite advances in overall care of critically ill patients, therapies specifically designated for sepsis were lacking. However, research unveiled a complex interaction between the coagulation and inflammation systems, which has served as an impetus for innovative pharmacologic therapies in the treatment of patients with sepsis. This article summarizes the results of trials involving drotrecogin alfa (activated), or recombinant human activated protein C, the only medicine currently approved by the US Food and Drug Administration for the treatment of severe sepsis. In addition, the beneficial effects of early, goal-directed resuscitation, guided by continuous central venous oxygen saturations, are discussed, with the issues involved in the use of corticosteroids in a subset of patients with septic shock. This article also reviews the beneficial effects of tight glycemic control in postoperative critically ill patients and considers whether the data can be extrapolated to medical patients.