Скачать или смотреть Sepsis Body Turns on Itself

Original article: Sepsis and Septic Shock
Citation: N Engl J Med. 2024;391:2133–2146. doi:10.1056/NEJMra2403213

Summary
This review article provides a comprehensive update on sepsis and septic shock, covering global epidemiology, pathophysiology, management, and future directions.

◯ What is sepsis?
It is life-threatening organ dysfunction caused by a dysregulated host response to infection. Annually, there are an estimated 48.9 million cases worldwide with 11 million deaths.

◯ Who is at highest risk?
Children under 5, older adults, and patients with cancer, immunosuppression, or on dialysis face the greatest risks. Most cases occur in low- and middle-income countries, with sub-Saharan Africa disproportionately affected.

◯ What happens inside the body?
Sepsis involves both excessive inflammation and immune suppression, alongside vascular injury. These combined processes lead to multi-organ failure and shock (illustrated in Figure 2 of the article).

◯ Core pillars of management
– Infection control (antimicrobials, source control procedures)
– Hemodynamic stabilization (fluids, vasopressors)
– Organ support (mechanical ventilation, renal replacement therapy)

◯ Key clinical trial insights
– Early goal-directed therapy (EGDT) showed no benefit over usual care
– Balanced crystalloids outperform normal saline for resuscitation
– Norepinephrine remains the first-line vasopressor
– Corticosteroids may help in persistent shock cases

◯ Long-term outcomes
Survivors often face cognitive decline, functional disability, and chronic disease exacerbation. Many cannot return to work, and persistent immune dysregulation has been observed.

◯ Future challenges
Efforts should focus on precision medicine approaches, better diagnostics, and infrastructure development in resource-limited regions.