Actualites therapeutiques en soins intensifs: le point sur le sepsis severe/choc septique et sur l'embolie pulmonaire

Septic shock and pulmonary embolism remain leading causes of death in intensive care units. Recent therapeutic advances have contributed to decrease the mortality rate of septic shock. Among these, early goal directed hemodynamic therapy, corticoid and activated protein C are the most efficient. However, due to the increased incidence of sepsis, the absolute number of deaths remains unacceptably high. In order to improve the prognosis of septic patients, the "surviving sepsis campaign" started in 2002. Its main objective is to decrease mortality rate of sepsis by 25% in the next five years. The diagnostic strategy of pulmonary embolism has been improved by the use of validated algorithms using clinical probability, d-dimers, angioscan and venous doppler. The growing use of low molecular weight heparin has also improved and facilitated the therapeutic management of pulmonary embolism while indication of fibrinolysis in presence of right ventricular dysfunction, but without shock, remains controversial.