Treatment

Largely supportive, though the cause should be removed/treated if at all possible. Treatment includes antibiotics, drainage of pus, fixation of femoral/ pelvic fractures and debridement of necrotic tissue.

An important facet of organ support is to minimise iatrogenic trauma. It is sufficient to maintain survival with relative homeostasis until recovery takes place rather than attempting to achieve normal physiological or biochemical target values. An example of this is permissive hypercapnia.

Specific treatment regimens remain contentious due to a lack of adequately powered studies showing optimal haemodynamic goals, inotropic/ pressor agents, antibiotic regimens, etc. Local policies may favour the use of one or more of a range of eclectic therapies that may offer a reasonable theoretical basis for administration, or anecdotal success, though theseall remain essentially unproven. Examples include antioxidants, protease inhibitors, immunonutrition, plasmapheresis, vasodilators, and immunoglobulins. It is generally agreed that rapid resucitation and restoration of oxygen delivery, glycaemic control and prompt removal of any treatable cause is desirable in preventing the onset of SIRS.

Because of non-standardisation of definitions, outcome data are conflicting, though single organ 'failure' carries an approximate 20-30% mortality while >3 organ 'failures' lasting >3 days carries a mortality in excess of 50%. Recovery is often complete in survivors, though recent studies are revealing long term physical and psychological sequelae in a significant proportion of patients.

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