Sepsis: time to reconsider the concept.
Détails
ID Serval
serval:BIB_DDC7FD6B3A0C
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Institution
Titre
Sepsis: time to reconsider the concept.
Périodique
Critical Care Medicine
ISSN
1530-0293
Statut éditorial
Publié
Date de publication
2008
Peer-reviewed
Oui
Volume
36
Numéro
3
Pages
964-946
Langue
anglais
Notes
Publication types: Journal Article ; Review
Résumé
OBJECTIVE: To discuss the difficulty in using the concept of sepsis for clinical trials and propose new ways for designing future trials for severe infections. DESIGN: Short position statement. METHODS AND MAIN RESEARCH: Using a thorough evaluation of the recent literature in the field of severe sepsis and septic shock, the authors challenge the concept of sepsis as used in the past two decades and propose new ideas for designing future trials in this setting. The two main proposals are first to use a systematic assessment of the targeted inflammatory mediators when the study intends to counteract or replace those mediators (e.g., anti-tumor necrosis factor-alpha, activated protein C) and, second, to select more homogeneous populations, coming back to "precise infectious diseases," such as severe community-acquired pneumonia, severe peritonitis, or meningitis. CONCLUSIONS: The concept of sepsis has been useful to help clinicians to suspect and detect severe infections. Due to a considerable heterogeneity in the patients and type of infections included in the trials performed in the last two decades, it has not been useful in demonstrating the efficacy of new compounds. The authors propose a dramatic change in the design of future trials dealing with severe infections.
Mots-clé
Clinical Trials as Topic, Forecasting, Humans, Sepsis, Severity of Illness Index, Shock, Septic
Pubmed
Web of science
Création de la notice
19/03/2009 18:18
Dernière modification de la notice
20/08/2019 17:02