Clinical Review State of the Art Review

Sepsis: pathophysiology and clinical management

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i1585 (Published 23 May 2016) Cite this as: BMJ 2016;353:i1585
  1. Jeffrey E Gotts, assistant professor1,
  2. Michael A Matthay, professor1
  1. 1Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA 94143-0624, USA
  1. Correspondence to: M A Matthay Michael.matthay{at}ucsf.edu

Abstract

Sepsis, severe sepsis, and septic shock represent increasingly severe systemic inflammatory responses to infection. Sepsis is common in the aging population, and it disproportionately affects patients with cancer and underlying immunosuppression. In its most severe form, sepsis causes multiple organ dysfunction that can produce a state of chronic critical illness characterized by severe immune dysfunction and catabolism. Much has been learnt about the pathogenesis of sepsis at the molecular, cell, and intact organ level. Despite uncertainties in hemodynamic management and several treatments that have failed in clinical trials, investigational therapies increasingly target sepsis induced organ and immune dysfunction. Outcomes in sepsis have greatly improved overall, probably because of an enhanced focus on early diagnosis and fluid resuscitation, the rapid delivery of effective antibiotics, and other improvements in supportive care for critically ill patients. These improvements include lung protective ventilation, more judicious use of blood products, and strategies to reduce nosocomial infections.

Footnotes

  • Contributors: JEG performed the literature search, wrote the draft article, and revised the manuscript. MAM edited early and revised versions of the manuscript, contributed as author to sections of the manuscript, and is guarantor.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: none.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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