Clinical indicators in sepsis and septic adult respiratory distress syndrome.

Sepsis and septic ARDS remain clinical problems of great significance because of the numbers of patients affected each year and the high mortality associated with development of the syndrome. The standard therapies for these conditions, judicious antibiotic administration and supportive care, continue to be the mainstays of treatment for these patients, but mortality even with optimal conventional therapy is between 50% and 90% for septic ARDS. The mortality for an individual patient may be anticipated to be substantially higher or lower than these average reported values, based on the presence or absence of several clearly identified risk factors, such as advanced age, shock, evidence of multiorgan system failure, and others discussed above. Similarly, the likelihood that the septic patient will develop ARDS is increased by the appearance of shock and thrombocytopenia. Two therapies that are used extensively in the intensive care unit today--corticosteroid administration and PEEP--have not been shown to reduce the overall mortality of sepsis or septic ARDS. Newer therapeutic modalities, designed to protect against or reverse cardiovascular consequences of sepsis, reduce the incidence of multiorgan system failure, and diminish the high incidence of uncontrolled infections in these patients, are needed; investigations of these interventions are in progress.