Septic Shock: Persisting Uncertainties Relating to Pathophysiologic Mechanisms and their Mediators,
BOSTON UNIV MA SCHOOL OF MEDICINE
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This limited review is intended solely as an overview of a clinicians perspective of the applicability of the extensive investigative efforts on septic shock to the care of the patients with Gram-negative bacteremia and shock. It is not intended as criticism of various investigations or investigators, but is specifically intended to emphasize the vast number of in vitro studies and our continuing lack of definitive information concerning the basic mechanisms responsible for the development and course of shock. As one who has watched the ebb and flow of popularity concerning the importance of a variety of postulated effectors and mediators, it is disappointing to this clinician that, to date, none have resulted in new therapies clearly shown to significantly improve survival rates in patients with septic shock. As stated earlier, it seems clear that newer antimicrobial agents will probably not further increase the salvage rates in those with septic shock and that further improvement will depend on improved methods of management of crucial hemodynamic derangements. The primary purpose of this review is to urge greater attention to the intact whole patient and less focus on in vitro phenomenology, unless this is clearly established to have clinical relevance.