New therapeutic alternatives for severe sepsis in the critical patient. A review

Loza Vázquez, A.; León Gil, C.; León Regidor, A.

doi:10.1016/S2173-5727(11)70031-5

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Abstract

Background

Despite efforts to establish uniform protocols for the management of severe sepsis, this condition continues to have high morbidity and mortality. This is due, among other factors, to the many barriers for the development of the protocols and the application time. That is why new therapeutic measures are continuing to be investigated and developed.

Objective

To review the literature on the new and future therapeutic alternatives available in the management of sepsis in critically ill patients.

Data source and search method

A search was made for articles consistent with evidence-based medicine guidelines published between 2004 and 2009 in different databases (Cochrane Plus Library, National Guideline Clearinghouse, Clinical Evidence, REMI and PubMed) and the NIH Clinical Trails database (ClinicalTrials.gov) using the TRIP meta-search engine.

Study selection

A total of 357 documents were retrieved, selecting 48 of which included systematic reviews, meta-analyses, clinical practice guidelines, structured abstracts of original articles, and clinical trials. The selection criteria followed the peer review process.

Data extraction

Data were extracted by two independent reviewers.

Conclusions

Based on the 2004–2009 study period, sufficient evidence was not obtained to make further recommendations on the treatment of sepsis. Although the abundant evidence needed to suggest the utility of these therapeutic measures, inhaled nitric oxide, statins, and immunoglobulins are probably good options for the adjuvant treatment of sepsis. However, we must wait for the results of different ongoing clinical trials on new treatment modalities. Stem cells and gene therapy will probably emerge as novel therapies in the future.

Keywords:

New therapies

Sepsis

Critically ill patient

Resumen

Introducción

La sepsis grave sigue teniendo elevadas morbilidad y mortalidad, a pesar de los esfuerzos realizados en la instauración de protocolos uniformes de actuación, debido, entre otros muchos factores, a la existencia de múltiples barreras para la implantación, así como su tiempo de aplicación. Es por ello que se sigue desarrollando e investigando sobre nuevas medidas terapéuticas.

Objetivo

Realizar una revisión de la literatura sobre las nuevas y futuras alternativas terapéuticas de que disponemos para el tratamiento de la sepsis en los pacientes críticos.

Fuentes de datos y método de búsqueda

Se llevo a cabo una búsqueda limitada por tiempo desde 2004 hasta 2009, a través del metabuscador Trip Database en las páginas de medicina basada en la evidencia (Cochrane Plus, National Guideline Clearinghouse, Clinical Evidence, REMI y PubMed) y base de datos de ensayos clínicos (ClinicalTrials.gov).

Selección de los estudios

Se obtuvieron de la búsqueda 357 documentos, de los cuales se seleccionaron 48 que incluyen revisiones sistemáticas, metaanálisis, guías de práctica clínica, resúmenes estructurados de un artículo original y ensayos clínicos. El método empleado para aplicar estos criterios se hizo mediante una revisión por pares.

Extracción de datos

Un posterior análisis por dos revisores independientes.

Conclusiones

En el periodo de estudio 2004–2009 no ha habido aportaciones con evidencia suficiente como para realizar nuevas recomendaciones en el tratamiento de la sepsis. Aunque no se aporta la abundante evidencia que señale la utilidad de estas medidas terapéuticas, probablemente el óxido nítrico inhalado, las estatinas y las inmunoglobulinas sean buenas alternativas en el tratamiento adyuvante de la sepsis. Tendremos que esperar, de todas maneras, los resultados de los diferentes ensayos clínicos que se encuentran en marcha sobre las nuevas terapias. El futuro posiblemente podría estar en las células madre y la genoterapia.

Palabras clave:

Nuevas terapias

Sepsis

Paciente crítico

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☆

These data were presented in part at the XXXI Congress of the Sociedad Andaluza de Medicina Intensiva, Urgencias y Coronarias (SAMIUC). Málaga, 12-14 November 2009.

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