Cardiovascular management of septic shock

Critical Care Medicine

Volumn 31, Issue 3, 2003, Pages 946-955

  Dellinger, R Phillip ^a,b  

^a RUTGERS ROBERT WOOD JOHNSON MEDICAL SCHOOL   (United States)

^b Camden NJ   (United States)

Author keywords

Bicarbonate; Drotrecogin alfa; Fluid resuscitation; Goal directed therapy; Norepinephrine; Septic shock; Severe sepsis; Steroids; Vasopressin; Vasopressors

Indexed keywords

ADRENALIN; ALPHA ADRENERGIC RECEPTOR STIMULATING AGENT; BICARBONATE; CARBICARB; DEXAMETHASONE; DICHLOROACETIC ACID; DOBUTAMINE; DOPAMINE; DROTRECOGIN; FLUDROCORTISONE; HYDROCORTISONE; HYPERTENSIVE FACTOR; INOTROPIC AGENT; MINERALOCORTICOID; NORADRENALIN; PHENYLEPHRINE; RECOMBINANT PROTEIN; STEROID; UNCLASSIFIED DRUG; VASOPRESSIN;

CLINICAL TRIAL; HUMAN; INCIDENCE; INTENSIVE CARE; INTENSIVE CARE UNIT; MORTALITY; PRACTICE GUIDELINE; PRIORITY JOURNAL; REVIEW; SEPTIC SHOCK;

ALGORITHMS; ANTI-INFLAMMATORY AGENTS; BICARBONATES; CARDIOTONIC AGENTS; CARDIOVASCULAR SYSTEM; CRITICAL CARE; DECISION TREES; FLUID THERAPY; HUMANS; INCIDENCE; MONITORING, PHYSIOLOGIC; OXYGEN CONSUMPTION; PROTEIN C; RESUSCITATION; SHOCK, SEPTIC; STEROIDS; TREATMENT OUTCOME; VASOCONSTRICTOR AGENTS; VASOPRESSINS;

EID: 0037352616     PISSN: 00903493     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.CCM.0000057403.73299.A6     Document Type: Review

References (142)

1. Dellinger RP: Current therapy for sepsis. Infect Dis Clin North Am 1999; 13:495-509
2. Kuhl DA: Current strategies for managing the patient with sepsis. Am J Health Syst Pharm 2002; 59:S9-S13
3. Sessler CN, Shepherd W: New concepts in sepsis. Curr Opin Crit Care 2002; 8:465-472
4. Finney SJ, Evans TW: Emerging therapies in severe sepsis. Thorax 2002; 57(Suppl II): ii8-ii14100
5. Opal SM, Fisher CJ Jr, Dhainaut JF, et al: Confirmatory interleukin-1 receptor antagonist trial in severe sepsis: A phase III, randomized, double-blind, placebo-controlled, multicenter trial. Crit Care Med 1997; 25:1115-1124
6. Pittet D, Hrbarth S, Sutter PM, et al: Efficacy and safety of recombinant human activated protein C for severe sepsis. Am J Respir Crit Care Med 1999; 160:852-857
7. Bernard G, Vincent JL, Laterre PF, et al: Efficacy and safety of human rhAPC for severe sepsis. N Engl J Med 2001; 344:749-762
8. Warren BL, Eid A, Singer P, et al: Caring for the critically ill patient. High-dose antithrombin III in severe sepsis: A randomized controlled trial. JAMA 2001; 286:1869-1878
9. Rivers E, Nguyen B, Havstad S, et al: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345:1368-1377
10. Angus DC, Linde-Zwirble WT, Lidicker J, et al: Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001; 29:1303-1310
11. Abraham E, Anzueto A, Gutierrez, et al: Double-blind randomised controlled trial of monoclonal antibody to human tumour necrosis factor in treatment of septic shock. Lancet 1998; 351:929-933
12. Baudo F, Caimi TM, de Cataldo F, et al: Antithrombin III (ATIII) replacement therapy in patients with sepsis and/or postsurgical complications: A controlled double-blind, randomized, multicenter study. Intensive Care Med 1998; 24:336-342
13. Bollaert PE, Charpentier, Levy B, et al: Reversal of late septic shock with supraphysiologic doses of hydrocortisone. Crit Care Med 1998; 26:645-650
14. Briegel J, Forst H, Halle M, et al: Stress doses of hydrocortisone reverse hyperdynamic septic shock: A prospective, randomized, double-blind, single-center study. Crit Care Med 1999; 27:723-732
15. Angus DC, Birmingham MC, Balk RA, et al: E5 murine monoclonal antendotoxin antibody in gram-negative sepsis: A randomized controlled trial. JAMA 2000; 283:1723-1730
16. Martin C, Viviand X, Leone M, et al: Effect of norepinephrine on the outcome of septic shock. Crit Care Med 2000; 28:2758-2765
17. Rank N, Michel C, Haertel C, et al: N-acetylcysteine increases liver blood flow and improves liver function in septic shock patients: Results of a prospective, randomized, double-blind study. Crit Care Med 2000; 28:3799-3807
18. Abraham E, Laterre PF, Garbino J, et al: Lenercept (p55 tumor necrosis factor receptor fusion protein) in severe sepsis and early septic shock: A randomized, double-blind, placebo-controlled, multicenter phase III trial with 1,342 patients. Crit Care Med 2001; 29:503-510
19. Abraham E, Reinhart K, Svoboda P, et al: Assessment of the safety of recombinant tissue factor pathway inhibitor in patients with severe sepsis: A multicenter, randomized, placebo-controlled, single-blind, dose escalation study. Crit Care Med 2001; 29:2081-2089
20. Jensen AG, Wachmann CH, Espersen F, et al: Treatment and outcome of Staphylococcus aureus bacteremia: A prospective study of 278 cases. Arch Intern Med 2002; 162:25-32
21. Cole L, Bellomo R, Hart G, et al: A phase II randomized, controlled trial of continuous hemofiltration in sepsis. Crit Care Med 2002; 30:100-106
22. Annane D, Sebille V, Charpentier C, et al: Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002; 288:862-871
23. Friedman G, Silva E, Vincent JL: Has the mortality of septic shock changed with time? Crit Care Med 1998; 26:2078-2086
24. Majno G: The ancient riddle of sigma eta psi iota sigma (sepsis). J Infect Dis 1991; 163:937-945
25. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992; 20:864-874
26. Marik PE, Varon J: The hemodynamic derangements in sepsis: Implications for treatment strategies. Chest 1998; 114:854-860
27. Parrillo JE, Parker MM, Natanson C, et al: Septic shock in humans: Advances in the understanding of pathogenesis, cardiovascular dysfunction, and therapy. Ann Intern Med 1990; 113:227-242
28. Landry DW, Oliver JA: The pathogenesis of vasodilatory shock. N Engl J Med 2001; 345:599-595
29. Llewelyn M, Cohen J: New insights into the pathogenesis and therapy of sepsis and septic shock. Curr Clin Top Infect Dis 2001; 21:148-171
30. Mackenzie IMJ: The haemodynamics of human septic shock. Anaesthesia 2001; 56:130-144
31. Metrangolo L, Fiorillo M, Friedman G, et al: Early hemodynamic course of septic shock. Crit Care Med 1995; 23:1971-1975
32. Nishijima H, Weil MH, Subin H, et al: Hemodynamic and metabolic studies on shock associated with Gram negative bacteremia. Medicine 1978; 52:287-294
33. Marx G, Vangerow B, Burczyk C, et al: Evaluation of noninvasive determinants for capillary leakage syndrome in septic shock patients. Intensive Care Med 2000; 26:1252-1258
34. Kumar A, Haery C, Parrillo JE: Myocardial dysfunction in septic shock. Crit Care Clin 2000; 16:251-287
35. Ellrodt AG, Riedinger MS, Kimchi A, et al: Left ventricular performance in septic shock: Reversible segmental and global abnormalities. Am Heart J 1985; 110:402-409
36. Parker MM, Shelhamer JH, Bacharach SL, et al: Profound but reversible myocardial depression in patients with septic shock. Ann Intern Med 1984; 100:483-490
37. Weisel RD, Vito L, Dennis RC, et al: Myocardial depression during sepsis. Am J Surg 1977; 133:512-521
38. Terborg C, Schummer W, Albrecht M, et al: Dysfunction of vasomotor reactivity in severe sepsis and septic shock. Intensive Care Med 2001; 27:1231-1234
39. Groeneveld ABJ, Nauta JJP, Thijs LG: Peripheral vascular resistance in septic shock: Its relation to outcome. Intensive Care Med 1988; 14:141-147
40. Vincent JL, Gris P, Coffernils M, et al: Myocardial depression characterizes the fatal course of septic shock. Surgery 1992; 111:660-667
41. Ince C, Sinaasappel M: Microcirculatory oxygenation and shunting in sepsis and shock. Crit Care Med 1999; 27:1369-1377
42. Cohn JD, Greenspan M, Goldstein CR, et al: Arteriovenous shunting in high cardiac output shock syndromes. Surg Gynecol Obstet 1968; 127:282-288
43. Hotchkiss RS, Karl IE: Reevaluation of the role of cellular hypoxia and biognergetic failure in sepsis. JAMA 1992; 267:1503-1510
44. Schwartz DR, Malhotra A, Fink MP: Cytopathic hypoxia in sepsis: An overview. Sepsis 1998; 2:279-289
45. Ruokonen E, Takala J, Kari A, et al: Regional blood flow and oxygen transport in spetic shock. Crit Care Med 1993; 21:1296-1303
46. Pastores SM, Katz DP, Kvetan V: Splanchnic ischemia and gut mucosal injury in sepsis and the multiple organ dysfunction syndrome. Am J Gastroenterol 1996; 91:1697-1710
47. Fink MP: Cytopathic hypoxia: Is oxygen use impaired in sepsis as a result of an acquired intrinsic derangement in cellular respiration? Crit Care Clin 2002; 18:165-175
48. Stein PD, Afzal A, Henry JW, et al: Fever in pulmonary embolism. Chest 2000; 117:39-42
49. Vella A, Nippoldt TB, Morris JC: Adrenal hemorrhage: A 25-year experience at the Mayo Clinic. Mayo Clin Proc 2001; 76:161-168
50. Chien GL, Wolff RA, Davis RF, et al: "Normothermic range" temperature affects myocardial infarct size. Cardiovasc Res 1994; 28:1014-1017
51. Ammann P, Fehr, Minder EI, et al: Elevation of troponin I in sepsis and septic shock. Intensive Care Med 2001; 27:965-969
52. Ortega-Carnicer J, Porras L, Alcazar R, et al: Silent transmural myocardial ischemia during septic shock in a patient with normal coronary arteries. Intensive Care Med 2001; 27:1098-1099
53. Wu AH: Increased troponin in patients with sepsis and septic shock: Myocardial necrosis or reversible myocardial depression? Intensive Care Med 2001; 27:959-961
54. Connors AJ Jr, Speroff T, Dawson NV, et al: The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA 1996; 276:889-897
55. Reynolds HN, Haupt MT, Thill-Baharozian MC, et al: Impact of critical care physician staffing on patients with septic shock in a university hospital medical intensive care unit. JAMA 1988; 260:3446-3450
56. Squara P, Bennett D, Perret C: Pulmonary artery catheter: Does the problem lie in the users? Chest 2002; 121:2009-2015
57. Stok WJ, Baisch F, Hillebrecht A, et al: Noninvasive cardiac output measurement by arterial pulse analysis compared with inert gas rebreathing. J Appl Physiol 1993; 74:2687-2693
58. Mehwald PS, Rusk RA, Mori Y, et al: A validation study of aortic stroke volume using dynamic 4-dimensional color Doppler: An in vivo study. J Am Soc Echocardiogr 2002; 15:1045-1050
59. Laupland KB, Bands CJ: Utility of esophageal Doppler as a minimally invasive hemodynamic monitor: A review. Can J Anaesth 2002; 49:393-401
60. Chaney JC, Derdak S: Minimally invasive hemodynamic monitoring for the intensivist: Current and emerging technology. Crit Care Med 2002; 30:2338-2345
61. Clements FM, de Bruijn NP: Noninvasive cardiac monitoring. Crit Care Clin 1988; 4:435-454
62. Buhre W, Weyland A, Kazmaier S, et al: Comparison of cardiac output assessed by pulse-contour analysis and thermodilution in patients undergoing minimally invasive direct coronary artery bypass grafting. J Cardiothorac Vasc Anesth 1999; 13:437-440
63. Choi PTL, Yip G, Quinonez LG, et al: Crystalloids vs. colloids in fluid resuscitation: A systemic review. Crit Care Med 1999; 27:200-210
64. Cook D, Guyatt G: Colloid use for fluid resuscitation: Evidence and spin. Ann Intern Med 2001; 135:205-208
65. Schierhout G, Roberts I: Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: A systematic review of randomised trials. BMJ 1998; 316:961-964
66. Rackow EC, Falk JL, Fein IA, et al: Fluid resuscitation in circulatory shock: A comparison of the cardiorespiratory effects of albumin, hetastarch, and saline soluntions in patients with hypovolemic and septic shock. Crit Care Med 1983; 11:839-850
67. LeDoux D, Astiz ME, Carpati CM, et al: Effects of perfusion pressure on tissue perfusion in septic shock. Crit Care Med 2000; 28:2729-2732
68. Gregory JS, Bonfiglio MF, Dasta JF, et al: Experience with phenylephrine as a component of the pharmacologic support of septic shock. Crit Care Med 1991; 19:1395-1400
69. Hanneman L, Reinhart K, Grenzer O, et al: Comparison of dopamine to dobutamine and norepinephrine for oxygen delivery and uptake in septic shock. Crit Care Med 1995; 23:1962-1970
70. Jindal N, Hollenberg SM, Dellinger RP: Pharmacologic issues in the management of septic shock. Crit Care Clin 2000; 16:233-249
71. Levy B, Bollaert PE, Charpentier C, et al: Comparison of norepinephrine and dobutamine to epinephrine for hemodynamics, lactate metabolism, and gastric tonometric variables in septic shock: A prospective, randomized study. Intensive Care Med 1997; 23:282-287
72. Susla GM, Takanishi G, Dellinger RP: Drugs used in critical care medicine. In: Critical Care Medicine: Principles of Diagnosis and Management in the Adult. Second Edition. Parrillo JE, Dellinger RP (Eds). St. Louis, Mosby, 2001, pp 312-368
73. Task Force for Hemodynamic Support of Sepsis in Adult Patients: Practice parameters for hemodynamic support of sepsis in adult patients. Crit Care Med 1999; 27:639-660
74. Martin C, Papazian L, Perrin G, et al: Norepinephrine or dopamine for the treatment of hyperdynamic septic shock? Chest 1993; 103:1826-1831
75. Van den Berghe G, de Zegher F: Anterior pituitary function during critical illness and dopamine treatment. Crit Care Med 1996; 24:1580-1590
76. Desjars P, Pinaud M, Bugnon D, et al: Norepinephrine therapy has no deleterious renal effects in human septic shock. Crit Care Med 1989; 17:426-429
77. Martin C, Eon B, Saux P, et al: Renal effects of norepinephrine used to treat septic shock patients. Crit Care Med 1990; 18:282-285
78. Rendl-Wenzl EM, Armbruster C, Edelmann G, et al: The effects of norepinephrine on hemodynamics and renal function in severe septic shock states. Intensive Care Med 1993; 19:151-154
79. Meadows D, Edwards JD, Wilkins RG, et al: Reversal of intractable septic shock with norepinephrine therapy. Crit Care Med 1988; 16:663-666
80. Martin C, Viviand X, Leone M, et al: Effect of norepinephrine on the outcome of septic shock. Crit Care Med 2000; 28:2758-2765
81. Holmes CL, Patel BM, Russell JA, et al: Physiology of vasopressin relevant to management of septic shock. Chest 2001; 120:989-1002
82. Altura BM: Dose-response relationships for arginine vasopressin and synthetic analogs on three types of rat blood vessels: Possible evidence for regional differences in vasopressin receptor sites within a mammal. J Pharmacol Exp Ther 1975; 193:413-423
83. Sharshar T, Carlier R, Blanchard A, et al: Depletion of neurohypophyseal content of vasopressin in septic shock. Crit Care Med 2002; 30:497-500
84. Reid IA: Rise of vasopressin deficiency in the vasodilation of septic shock. Circulation 1997; 95:1108-1110
85. Morales MD, Madigan J, Cullinane S, et al: Reversal by vasopressin of intractable hypotension in the late phase of hemorrhagic shock. Circulation 1999; 100:226-229
86. Argenziano M, Choudhri AF, Oz M, et al: A prospective randomized trial of arginine vasopressin in the treatment of vasodilatory shock after left ventricular assist device placement. Circulation 1997; 96:II-286-II-290
87. Dunser MW, Mayr AJ, Ulmer H, et al: The effects of vasopressin on systemic hemodynamics in catecholamine-resistant septic and postcardiotomy shock: A retrospective analysis. Anesth Analg 2001; 93:7-13
88. Malay MB, Ashton RC, Landry DW, et al: Low-dose vasopressin in the treatment of vasodilatory septic shock. J Trauma 1999; 47:699-705
89. Grover R, Lopez A, Larente J, et al: Multicenter, randomized, placebo-controlled, double blind study of the nitric oxide-synthase inhibitor 546C88: Effect on survival in patients with septic shock. Abstr. Crit Care Med 1999; 27(Suppl):A33
90. Poole-Wilson PA, Langer GA: Effect of pH on ionic exchange and function in rat and rabbit myocardium. Am J Physiol 1975:229;570-581
91. Forsythe SM, Schmidt GA: Sodium bicarbonate for the treatment of lactic acidosis. Chest 2000; 117:260-267
92. Shapiro JI: Functional and metabolic responses of isolated hearts to acidosis: Effects of sodium bicarbonate and carbicarb. Am J Physiol 1990; 258:H1835-H1839
93. Nakanishi T, Okuda H, Kamata K, et al: Influence of acidosis on inotropic effect of catecholamines in new born rabbit hearts. Am J Physiol 1987; 253:H1441-H1448
94. von Planta I, Weil MH, von Planta M, et al: Hypercarbic acidosis reduces cardiac resuscitability. Crit Care Med 1991; 19:1177-1182
95. Cooper DJ, Walley KR, Wiggs BR, et al: Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis: A prospective, controlled clinically study. Ann Intern Med 1990; 112:492-498
96. Mathieu D, Neviere R, Billard V, et al: Effects of bicarbonate therapy on hemodynamics and tissue oxygenation in patients with lactic acidosis: A prospective, controlled clinical study. Crit Care Med 1991; 19:1352-1356
97. Rhee KH, Toro LO, McDonald GG, et al: Carbicarb, sodium bicarbonate, and sodium chloride in hypoxic lactic acidosis: Effect on arterial blood gases, lactate concentrations, hemodynamic variables, and myocardial intracellular pH. Chest 1993; 104:913-918
98. Stacpoole PW, Wright EC, Baumgartner TG, et al: A controlled clinical trial of dichloroacetate for treatment of lactic acidosis in adults. N Engl J Med 1992; 327:1564-1569
99. Archie JP: Mathematic coupling of data. Ann Surg 1981; 193:296
100. Levy B, Bollaert PE, Charpentier C, et al: Comparison of norepinephrine and dobutamine to epinephrine for hemodynamics, lactate metabolism, and gastric tonometric variabiles in septic shock: A prospective, randomized, study. Intensive Care Med 1997; 23:282-287
101. Gore DC, Jahoor F, Hibbert JM, et al: Lactic acidosis during sepsis is related to increased pyruvate production, not deficits in tissue oxygen availability. Ann Surg 1996; 224:97-102
102. Gammaitoni C, Nasraway SA: Normal lactate/pyruvate ratio during overwhelming polymicrobial bacteremia and multiple organ failure. Anesthesiology 1993; 80:213-216
103. Boyd O, Grounds RM, Bennett ED: A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. JAMA 1993; 270:2699-2707
104. Yu M, Levy MM, Smith P, et al: Effect of maximizing oxygen delivery on morbidity and mortality rates in critically ill patients: A prospective, randomized, controlled study. Crit Care Med 1993; 21:830-838
105. Shoemaker WC, Appel PL, Kram HG, et al: Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 1988; 94:1176-1186
106. Shoemaker WC, Appel PL, Kram HB, et al: Sequence of physiologic patterns in surgical septic shock. Crit Care Med 1993; 21:1876-1889
107. Tuchschmidt J, Fried J, Astiz M, et al: Elevation output and oxygen delivery improves outcome in septic shock. Chest 1992; 102:216-220
108. Gattinoni L, Brazzi L, Pelosi P, et al: A trial of goal-oriented hemodynamic therapy in critically ill patients. N Engl J Med 1995; 333:1025-1032
109. Hayes MA, Timmins AC, Yau EHS, et al: Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 1994; 330:1717-1722
110. Hebert PC, Wells G, Blajchman MA, et al: A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999; 340:409-417
111. Cassidy JE: Therapy in collapse due to meningococcus infection. Ann Intern Med 1957; 46:1099-1104
112. Meduri GU: An historical review of glucocorticoid treatment in sepsis: Disease pathophysiology and the design of treatment investigation. Sepsis 1999; 3:21-38
113. Wagner HM, Bennett IL, Lasagna L, et al: The effect of hydrocortisone upon the course of pneumococcal pneumonia treated with penicillin. Bull Johns Hopkins Hosp 1956; 98:197-215
114. Weil MH, Shubin H, Biddle M: Shock caused by Gram-negative microorganisms: Analysis of 169 cases. Ann Intern Med 1964; 60:384-400
115. Weil MH, Spink WW: The shock syndrome associated with bacteremia due to Gram-negative bacilli. Arch Intern Med 1958; 101:184-193
116. Weitzman S, Berger S: Clinical trial design in studies of corticosteroids for bacterial infections. Ann Intern Med 1974; 81:36-42
117. Kinsell LW, Jahn JP: The use of corticoids in association with antibiotics in the management of unusually severe infections. Ann Intern Med 1955; 43:397-407
118. Schumer W: Steroids in the treatment of clinical septic shock. Ann Surg 1976; 333-341
119. Bone RC, Fisher CJ, Clemmer TP, et al: A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med 1987; 317:653-658
120. Sprung CL, Caralis PV, Marcial EH, et al: The effects of high-dose corticosteroids in patients with septic shock. N Engl J Med 1984; 311:1137-1143
121. Cronin L, Cook DJ, Carlet J, et al: Corticosteroid treatment for sepsis: A critical appraisal and meta-analysis of the literature. Crit Care Med 1995; 23:1430-1439
122. Lefering R, Neugebauer EAM: Steroid controversy in sepsis and septic shock: A meta-analysis. Crit Care Med 1995; 23:1294-1303
123. Bollaert PE, Charpentier C, Levy B, et al: Reversal of late septic shock with supraphysiologic doses of hydrocortisone. Crit Care Med 1998; 26:645-650
124. Briegel J, Forst H, Haller M, et al: Stress doses of hydrocortisone reverse hyperdynamic septic shock: A prospective, randomized, double-blind, single-center study. Crit Care Med 1999; 27:723-732
125. Annane D, Sebille V, Troche G, et al: A 3-level prognostic classification in septic shock based on cortisol levels and cortisol response to corticotropin. JAMA 2000; 283:1038-1045
126. Annane D, Sebille V, Charpentier C, et al: Effect of treatment with low dose of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002; 288:862-871
127. Marik PE, Zaloga GP: Adrenal insufficiency in the critically ill: A new look at an old problem. Chest 2002; 122:1784-1796
128. Faust SN, Levin M, Harrison OB, et al: Dysfunction of endothelial protein C activation in severe meningococcal sepsis. N Engl J Med 2001; 345:408-416
129. Wenzel RP: Treating sepsis. N Engl J Med 2002; 347:966-967
130. Warren HS, Suffredini AF, Eichacker PQ, et al: Risks and benefits of activated protein C treatment for severe sepsis. N Engl J Med 2002; 347:1027-1030
131. Siegel JP: Assessing the use of activated protein C in the treatment of severe sepsis. N Engl J Med 2002; 347:1030-1034
132. Manns BJ, Lee H, Doig CJ, et al: An economic evaluation of activated protein C treatment for severe sepsis. N Engl J Med 2002; 347:993-1000
133. Fourrier F, Chopin C, Huart JJ, et al: Double-blind, placebo-controlled trial of antithrombin III concentrates in septic shock with disseminated intravascular coagulation. Chest 1993; 104:882-888
134. Warren BL, Eid A, Singer P, et al: High-dose antithrombin III in severe sepsis. JAMA 2001; 286:1869-1878
135. De Vriese AS, Colardyn FA, Philippe JJ, et al: Cytokine removal during continuous hemofiltration in septic patients. J Am Soc Nephrol 1999; 10:846-853
136. Cole L, Bellomo R, Journois D, et al: High-volume haemofiltration in human septic shock. Intensive Care Med 2001; 27:987-986
137. Ronco C, Brendolan A, Lonnemann G, et al: A pilot study of coupled plasma filtration with absorption in septic shock. Crit Care Med 2002; 30:1250-1255
138. Mariano F, Tetta C, Guida G, et al: Hemofiltration reduces the serum priming activity on neutrophil chemiluminescence in septic patients. Kidney Int 2001; 60:1598-1605
139. Reiter K, Bellomo R, Ronco C, et al: Pro/con clinical debate: Is high-volume hemofiltration beneficial in the treatment of septic shock? Crit Care 2002; 6:18-21
140. Busund R, Koukline V, Utrobin U, et al: Plasmapheresis in severe sepsis and septic shock: A prospective, randomized, controlled trial. Intensive Care Med 2002; 28:1434-1439
141. Stegmayr BG: Plasmapheresis in severe sepsis or septic shock. Blood Purif 1996; 14:94-101
142. Werden K: Intravnous immunoglobulin for prophylaxis and therapy of sepsis. Curr Opin Crit Care 2001; 7:345-361