The use of drotrecogin alfa recombinant activated protein C for severe sepsis in the critically burned patient: A new treatment approach

摘要

Burn patients are particularly predisposed to infection, sepsis, and multiple organ failure, A "two-hit" model has been proposed to explain the relationship between burns, sepsis and organ failure. The first hit is an extensive thermal injury, which primes the host to exhibit an abnormal response, including increased pro-inflammatory mediator release. This predisposes the host to the second hit, sepsis, thus leading to multiple organ failure and death . While the exact process leading to multi-system-organ failure in burn patients is complex and multifactorial, a macrophage-mediated cascade is largely implicated in the pathway. It is believed that direct tissue injury, i.e., the first hit, brought on by a burn stimulates or "primes" macrophages. Systemic infection can easily ensue because burn patients are highly susceptible due to the loss of skin protection, the introduction of invasive lines, and prolonged intubation.