We selected relevant literature published in English based largely on our personal knowledge of developments in sepsis research.
ViewpointSepsis: older and newer concepts
Introduction
Sepsis is hard to define. The word sepsis has been around for centuries, and was used as early as the time of the ancient Greeks (σηψiς) to describe decomposition or putrefaction.1 The term thus existed long before anything was known about the microorganisms and immunological responses responsible for this often lethal condition. Although the clinical picture of sepsis has not changed much since those early days, our ability to support failing organs has altered how we manage sepsis, such that individuals can now survive severe infections that would previously have been fatal. With these advances in organ support, many aspects of the immunological response have been unravelled, and our understanding of the basic pathogenesis and pathophysiology of sepsis has improved. Along with these changes, the realisation of the importance of early diagnosis and management, and the need to identify appropriate patient groups for clinical research,2 has come a need to define sepsis more precisely.
Section snippets
Older concepts
A North American consensus definitions conference held in 19913 caused considerable controversy when the participants attempted to simplify the concept by proposing that sepsis represented the association between infection and signs of the systemic inflammatory response syndrome. The presence of infection is certainly essential for a diagnosis of sepsis. Some patients might have a sepsis-like state without evidence of an infection4—a good example is a patient who develops a hyperkinetic state
Newer concepts
In 2001, an attempt was made to revisit the systemic inflammatory response syndrome criteria,11 but the resultant list of signs and symptoms of sepsis was too long to be widely accepted, and the systemic inflammatory response syndrome criteria, however inadequate, continued to be used. In 2014, the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine put together a group of experts (including J-LV, one of the coauthors of this Viewpoint) from different
Conclusion
So, is this new consensus a big step? Not really, but it is a welcome and necessary update. The systemic inflammatory response syndrome was a (long) hiccup in the history of sepsis, and we are now heading back towards a more representative and realistic definition. Just as monitoring alone cannot improve outcomes,17 altered definitions cannot be said to represent major progress in terms of patient management. Introduction of the new Berlin definitions of acute respiratory distress syndrome18
Search strategy and selection criteria
References (19)
- et al.
Sepsis: a roadmap for future research
Lancet Infect Dis
(2015) - et al.
Sepsis definitions: time for change
Lancet
(2013) - et al.
Assessment of the worldwide burden of critical illness: the Intensive Care Over Nations (ICON) audit
Lancet Respir Med
(2014) - et al.
Historical perspective of the word “sepsis”
Intensive Care Med
(2006) Consensus conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis
Crit Care Med
(1992)Dear SIRS, I'm sorry to say that I don't like you…
Crit Care Med
(1997)- et al.
Systemic inflammatory response syndrome criteria in defining severe sepsis
N Engl J Med
(2015) - et al.
Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012
JAMA
(2014) - et al.
Regulatory mandates for sepsis care—reasons for caution
N Engl J Med
(2014)
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