OBJECTIVE: To examine three typical disease states seen in intensive care, sepsis, Fulminant purpura and acute respiratory distress syndrome (ARDS) to assess the implication of cytokines in their pathogenesis and particularly in the clinical applications of possible cytokine inhibitors.
SOURCE OF DATA: The data bank of MedLine and the Index Medicus 1985-1993 and the first part of 1994. These sources have enabled us to consult publications in French and English and to include information on both animals and humans. The publications issued from Intensive Care Congresses have also been scrutinised; the Société de Réanimation de Langue Française, The American Thoracic Society and the 13th and 14th International Symposium on Intensive Care and Emergency Medicine, Brussels. SELECTION OF DATA: This review emphasizes certain areas of work including recognised work which has been published on the immunotherapy of sepsis in man, on those papers which have been published as a preliminary communication in the from of a summary and on certain papers relating to animal work which are regularly cited in Intensive Care literature.
DISCUSSION: The relationship between cytokines and the three selected disease states have been briefly described. The greater part of those papers which have either been published or are in the process of being published present pharmacotherapeutic data in phase 2 or phase 3 in relationship to anticytokines and sepsis. As for the treatment of Fulminant purpura and ARDS, using anticytokine antibodies in 1994 we are still in the stage of hypothesis and speculation.
CONCLUSIONS: Future clinical strategies designed to combat. Future clinical strategies designed to fight against the most critical diseases in intensive care medicine require some use of any kind of immunotherapy. In animal studies, convincing data are available showing that immunotherapy improves the prognosis of sepsis, whereas in humans, to date, the results appear to be deceiving. Future research in this direction is mandatory, in sepsis and in other disease states, like ARDS, because no other hope for treating these patients seems to appear in a near future.