Sepsis and its complications: the clinical problem.

OBJECTIVES: To review the difficulties associated with defining sepsis and its complications and to characterize the role of the proinflammatory cytokines in the development of human septic shock, adult respiratory distress syndrome, and the systemic inflammatory response syndrome.

DATA SOURCES: Information presented at the 22nd Educational and Scientific Symposium of the Society of Critical Care Medicine on June 9-13, 1993 in New York City was reviewed, along with supportive documentation from the English language literature.

STUDY SELECTION: Human studies that provide evidence for the definitions of sepsis and related entities.

DATA EXTRACTION: This review focused on those data that described the role of selected cytokines in septic shock.

DATA SYNTHESIS: Information concerning the evolution of the definition of sepsis and its sequelae was integrated with considerations used for patient identification for clinical trials involving novel septic shock therapies.

CONCLUSIONS: Sepsis and its complications constitute a complex biological cascade that may be defined by specific clinical characteristics. The clinical variability in these events suggests that definitions based on clinical end points be used in combination with assessments of severity of illness to best define patient status, predict clinical course, and guide treatment decision-making.