الفهرس 
Pathophysiology of sepsis.Only 14 pages are availabe for public view
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Abstract
Sepsis is the leading cause of death in medical intensive care units. In most fatal cases of sepsis the patient experiences an insidious, progressive decline in vital organ function, i.e. multiple organ dysfunction syndrome (MODS), which is commonly associated with signs of accelerated anaerobic metabolism despite supernormal systemic oxygen delivery.
The normal host response to infection is a complex process that localizes and controls bacterial invasion, while initiating the repair of injured tissue. It involves the activation of circulating and fixed phagocytic cells, as well as the generation of proinflammatory and antiinflammatory mediators. Sepsis results when the response to infection becomes generalized and involves normal tissues remote from the site of injury or infection.
The role of mitochondrial dysfunction in sepsis remains controversial, and its contribution to the development of organ dysfunction is unknown. Some authors have argued that the decreased mitochondrial function observed in experimental and/or clinical studies might represent an adaptive mechanism, occurring in response to varying degrees of tissue hypoperfusion and hypoxia. This state has been termed ‘‘mitochondrial hibernation’’, which can be characterized by a cellular down-regulation of all non-essential functions, followed by a decreased global rate of oxygen and ATP consumption. The hibernation phenomenon may explain the observations that organ dysfunction and failure in sepsis were seldom associated with histopathological damage.
Management of sepsis is in a great advance. The Surviving Sepsis Campaign guidelines have been updated every four years with the most
recent update in 2016, and the current versions reflect the opinion of a reasonable approach to the treatment of septic shock. In response to the European Society of Intensive Care Medicine’s and the Society of Critical Care Medicine’s Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), the Surviving Sepsis Campaign (SSC) offered clarification on the implications of the new definition statements and guidance for hospitals and practitioners that is meant to put the recent publication of the consensus definitions in context to facilitate the continued successes of sepsis screening, early identification and treatment that have been the hallmark of SSC’s quality improvement efforts associated with improved survival during the preceding decade.