Editorial Views  |   July 2018
Immunotherapy for Sepsis: A Good Idea or Another Dead End?
Author Notes
  • From the Keenan Research Centre for Biomedical Research, St. Michael’s Hospital, Toronto, Canada; and the Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, Canada.
  • Corresponding article on page 131.
    Corresponding article on page 131.×
  • Accepted for publication March 20, 2018.
    Accepted for publication March 20, 2018.×
  • Address correspondence to Dr. Lee: leew@smh.ca
Article Information
Editorial Views / Critical Care / Infectious Disease
Editorial Views   |   July 2018
Immunotherapy for Sepsis: A Good Idea or Another Dead End?
Anesthesiology 7 2018, Vol.129, 5-7. doi:10.1097/ALN.0000000000002237
Anesthesiology 7 2018, Vol.129, 5-7. doi:10.1097/ALN.0000000000002237
THE treatment of sepsis remains an intractable problem in critical care. It has been called the “graveyard”1  for pharmaceutical companies in recognition of dozens of negative clinical trials; this reflects multiple distinct approaches that appeared promising based on in vitro experiments and animal models but that failed to improve survival in patients with sepsis. To date, the only therapies for sepsis remain supportive care, including prompt administration of antibiotics, adequate source control of the underlying infection (if known), and vigilance to prevent iatrogenicity and the other complications of being critically ill. The lack of a specific therapy for sepsis reflects our inadequate understanding of its pathogenesis. While it was initially believed that an “excessive” inflammatory response accounted for the manifestations of sepsis, antiinflammatory therapy was persistently unsuccessful in human clinical trials.2  Now, a dominant theory for what causes death in sepsis is that the immune system becomes anergic, making patients vulnerable to nosocomial infection.3  It has been suggested that patients with sepsis therefore be treated with immunostimulants.4 
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