Sepsis and Innovative Treatment: The Odyssey R. C. Bone The Odyssey by
Homer, dates back to the 8th century, B. C. [1]. It is a great epic
adventure of Odysseus's dramatic journey from Troy back home to Ithaca.
Odysseus survives the ordeals of this journey and returns with new
powers and insights. The study of the pathogenesis and treatment of
sepsis has also been an odys- sey. I feel we will return from this
odyssey with new insights and treatments. However, as with Odysseus,
this will occur only after considerable struggle. In the 1980s we had a
rather simplistic view of sepsis. It was a highly lethal complication
caused by infection and often charac- terized by shock and multi-organ
failure. Our knowledge of the inflammatory responses associated with
sepsis was embryonic compared to today. The inflammatory response was
often treat- ment with mega-dose corticosteroids along with fluid
resuscita- tion, vasopressors and antibiotics. Because of the paucity of
mul- ti-center controlled trials documenting the risk/benefit ratio of
the treatment of sepsis with corticosteroids, two large multi-cen- ter
controlled trials were organized to evaluate the role of corti-
costeroids in sepsis [2, 3]. Because animal models showed bene- fits
of corticosteroids only with pre-treatment or early treatment, a
definition of sepsis was used that did not require positive cul- ture
documentation or septic shock to be included in the studied population.