Innovative therapies for sepsis

Sepsis and septic shock continue to be a major cause of morbidity and morta lity. Despite numerous advances in the supportive care of patients with sep sis, the overall mortality has changed little in the past 20 years. Many in novative therapies have been attempted in the field of sepsis, primarily ai med at stopping the cycle of cytokine activation which is part of the syste mic inflammatory response. Therapies have also targeted other molecular med iators of inflammation and coagulation. Despite encouraging preliminary pre clinical results, most of the early trials in sepsis research have failed t o offer hope of improving survival with the use of these innovative therapi es. Postulated reasons for the failure of clinical trials include the dispa rity between animal models and clinical reality, the heterogeneous nature o f patient populations and sepsis, and the complexity of the inflammatory ca scade. On a more hopeful note, three recent trials assessing corticosteroid s, anti-tumour necrosis factor strategy and drotrecogin alfa. (rhAPC), resp ectively, have proclaimed positive results. However, only the drotrecogin a lfa trial has been peer reviewed and published.