Logo Medical Science Monitor

Call: +1.631.470.9640
Mon - Fri 10:00 am - 02:00 pm EST

Contact Us

Logo Medical Science Monitor Logo Medical Science Monitor Logo Medical Science Monitor

10 April 2006

Comment to: Septic shock; current pathogenetic concepts from a clinical perspective.

Konstantinos G. Tsalis

Med Sci Monit 2006; 12(4): LE4-4 :: ID: 448942


Dear Editor, I really enjoyed the article of Dr A. Tsiotou et al. entitled"Septic shock; current pathogenetic concepts from a clinical perspective" [1]. I found it very interestingbecause it is well known that the yearly incidence of sepsis is 50-95 cases per 100.000, and has beenincreasing by 9% each year [2]. Furthermore, 3% of patients with severe sepsis experience septic shockwhich accounts for 10% of admissions to intensive care units [3,4]. The pathophysiologic process of septicshock is an extremely complex cascade of events that includes proinflammatory, anti-inflammatory, humoral,cellular, and circulatory involvement [5]. These factors are extensively and analytically reviewed inthis article. Excessive production of Nitric Oxide(NO) has been implicated in the pathogenesis of septicshock for a long time. As it is noticed in the article, the inhibition of NO in the context of septicshock in experimental models has demonstrated a survival advantage. But it has to be noticed that inthe pivotal clinical trial for the nitric oxide synthase inhibitor NG-methyl-L-arginine hydrochloride(546C88)the mortality was higher in the treatment arm [6]. Furthermore, another clinical trial showed that theintravenous administration of the nitric oxide synthase inhibitor 546C88 had as a result more rapid shockresolution although with reduced cardiac output and no survival difference [7,8]. Critical illness polyneuropathyand polymyopathy is a syndrome that has to be always mentioned when facing patients with sepsis because,as it is noticed in this review, the incidence is often more than 50% in ICU patients. Finally it iswell pointed out in this review that sometimes organ dysfunction may be due to a therapeutic intervention.The use of packed erythrocyte transfusions, for example, is associated with the transmission of potentialviral and bacterial infections, immune modulation, graft-versus-host disease, volume overload, and transfusion-relatedacute lung injury [9,10]. Administration of packed erythrocytes has also been suspected of triggeringa proinflammatory response that may serve as a "second hit" which could trigger the development of multipleorgan dysfunction syndrome [11]. Thus the patient with sepsis is subject to the various complicationsthat are frequently encountered in the critically ill patient, many of which are preventable with theuse of prophylactic strategies. Sincerelly, Konstantinos G. Tsalis, Associate Professor of Surgery, SurgicalDepartment, Aristotle University of Thessaloniki, Thessaloniki, Greece, e-mail: [email protected] References:1. Tsiotou AG, Sakorafas GH, Anagnostopoulos G, Bramis J: Septic shock; current pathogenetic conceptsfrom a clinical perspective. Med Sci Monit, 2005; 11(3): RA76-85 2. American College of Chest Physicians/Societyof Critical Care Medicine. Consensus Conference: definitions for sepsis and organ failure and guidelinesfor the use of innovative therapies in sepsis. Crit Care Med, 1992; 20: 864-74 3. Rangel-Frausto MS,Pittet D, Hwang T et al: The dynamics of disease progression in sepsis: Markov modeling describing thenatural history and the likely impact of effective antisepsis agents. Clin Infec Dis, 1998; 27: 185-904. Annane D, Aegerter P, Jars-Guinsestre MC, Guidet B: Current epidemiology of septic shock: the CUB-ReaNetwork. Am J Respir Crit Care Med, 2003; 1687: 165-72 5. Hotchkiss RS, Karl IE: The pathophysiologyand treatment of sepsis. N Engl J Med, 2003; 342: 138-50 6. Lopez A, Lorente JA, Steingrub J et al: Multiple-center,randomized, placebo-controlled, double-blind study of nitric oxide synthase inhibitor 546C88: effecton survival in patients with septic shock. Crit Care Med, 2004; 32: 21-30 7. Watson D, Grover R, AnzuetoA, et al. Cardiovascular effects of the nitric oxide synthase inhibitor NG-methyl-L-arginine hydrochloride(546C88)in patients with septic shock: results of a randomised, double-blind, placebo-controlled multicenterstudy(study no. 144-002). Crit Care Med, 2004; 32: 13-20 8. Bakker J, Griver R, McLuckie A et al: Administrationof nitric oxide synthase inhibitor NG-methyl-L-arginine hydrochloride(546C88) by intravenous infusionfor up to 72 hours can promote the resolution of shock in patients with severe sepsis; results of a randomised,double-blind, placebo-controlled multicenter study(study no.144-002). Crit Care Med, 2004; 32-1-12 9.Kopko PM, Marshall CS, Mackenzie MR: Transfusion-related acute lung injury. JAMA, 2002; 287: 1968-7110. Tsalis K, Ganidou M, Blouchos K et al: Transfusion related acute lung injury: a life threateningtransfusion reaction. Med Sci Monit, 2005; 11(5): CS19-22 11. Aiboshi J, Moore EE, Ciesla DJ et al: Bloodtransfusion and the two-insult model of post-injury multiple organ failure. Shock, 2001; 12: 302-6.

Keywords: Nitric Oxide - metabolism, Shock, Septic - pathology

Add Comment 0 Comments


01 May 2024 : Editorial  

Editorial: First Regulatory Approval for Adoptive Cell Therapy with Autologous Tumor-Infiltrating Lymphocytes (TILs) – Lifileucel (Amtagvi)

Dinah V. Parums

DOI: 10.12659/MSM.944927

Med Sci Monit 2024; 30:e944927

In Press

Database Analysis  

Long-Term Prognosis of Patients Undergoing Percutaneous Coronary Intervention: The Impact of Serum Creatini...

Med Sci Monit In Press; DOI: 10.12659/MSM.943063  

Database Analysis  

Maternal Exposure to Environmental Air Pollution and Premature Rupture of Membranes: Evidence from Southern...

Med Sci Monit In Press; DOI: 10.12659/MSM.943601  

Animal Research  

Enhanced Bone Healing Through Systemic Capsaicin Administration: An Experimental Study on Wistar Rats

Med Sci Monit In Press; DOI: 10.12659/MSM.942485  

Clinical Research  

Differential Inflammatory Responses in Adult and Pediatric COVID-19 Patients: Implications for Long-Term Co...

Med Sci Monit In Press; DOI: 10.12659/MSM.944052  

Most Viewed Current Articles

17 Jan 2024 : Review article  

Vaccination Guidelines for Pregnant Women: Addressing COVID-19 and the Omicron Variant

DOI :10.12659/MSM.942799

Med Sci Monit 2024; 30:e942799


14 Dec 2022 : Clinical Research  

Prevalence and Variability of Allergen-Specific Immunoglobulin E in Patients with Elevated Tryptase Levels

DOI :10.12659/MSM.937990

Med Sci Monit 2022; 28:e937990


16 May 2023 : Clinical Research  

Electrophysiological Testing for an Auditory Processing Disorder and Reading Performance in 54 School Stude...

DOI :10.12659/MSM.940387

Med Sci Monit 2023; 29:e940387


01 Jan 2022 : Editorial  

Editorial: Current Status of Oral Antiviral Drug Treatments for SARS-CoV-2 Infection in Non-Hospitalized Pa...

DOI :10.12659/MSM.935952

Med Sci Monit 2022; 28:e935952


Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750