improved understanding of the pathophysiology of sepsis: setting the scene for potential novel adjunctive therapies

The occurrence of sepsis in the critically ill population is a dreaded phenomenon when taking into consideration the devastating complications associated with the disease. Despite its high incidence and unacceptably high mortality, this complex syndrome remains poorly understood in terms of defining the disease, detecting the presence or absence of an infection, and therapeutic strategies to optimise immediate and long-term outcomes. Global efforts to address these issues coupled with significant advances in medical technologies and our improved understanding of the pathophysiology of the disease have led to some exciting developments in the domain of adjunctive therapies for sepsis. In particular, interest has focused around immunomodulation strategies and metabolic resuscitation. Some of these therapies sound particularly promising in terms of the early available evidence. The concept of personalised or individualised medicine takes centre stage when considering such therapies, as it is becoming increasingly evident that in order to achieve benefits, we need to introduce appropriate therapies at the right time, the right dose and for an appropriate duration. This review encapsulates a selection of these new adjunctive therapies.