Pharmacological treatment of septic shock

Septic shock remains as an important cause of morbidity and mortality. In spite of better antimicrobial and support treatment, death due to septic shock has increased in several groups of patients. In recent years, an improved understanding of the pathogenesis of sepsis and the advances in molecular biology and biotechnology, have led to the research on new treatments. Potential therapeutic compounds are able to interfere with endotoxins and cytokine pathways, such as that of TNF-alpha, and to prevent tissue damage by other inflammatory mediators such as complement, lipid compounds, bradykinins, leukocyte adhesion molecules, nitric oxide (NO), the coagulation cascade, opioids, endothelin and vasopressin. The use of angiotensin-converting enzyme (ACE) inhibitors, protease inhibitors and immune modulation is also discussed. This article reviews the physiopathology, the rationale, efficacy and shortcomings of agents for the treatment of septic shock in human and animal models.