Sepsis, the Sepsis Syndrome, Multi-Organ Failure: A Plea for Comparable Definitions (1991)

Editorials15 February 1991Sepsis, the Sepsis Syndrome, Multi-Organ Failure: A Plea for Comparable DefinitionsRoger C. Bone, MDRoger C. Bone, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-114-4-332 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptPrecision in language is no trivial matter. Considerable confusion arises when terms are defined differently by different clinical subspecialties, or even within a given field. Such is the predicament that has arisen regarding the related, but overlapping terms used for the various degrees of severe clinical infection. Everyone has a vague notion of what the terms bacteremia, septicemia, sepsis, the sepsis syndrome, and septic shock mean. Too often, however, these words are used interchangeablyin speech and in the professional literature, which can lead to considerable bewilderment. Because clinical protocols are based on specific criteria understood by the developers of a...References1. BoneFisherClemmerSlotmanMetzBalk RCTGCR. A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med. 1987;317:353-8. CrossrefGoogle Scholar2. SprungCaralisMarcial CPE. The effects of high-dose corticosteroids in patients with septic shock. A prospective, controlled study. N Engl J Med. 1984;311:1137-43. CrossrefMedlineGoogle Scholar3. . Effect of high-dose glucocorticoid therapy on mortality in patients with clinical signs of sepsis. N Engl J Med. 1987;317:659-65. CrossrefMedlineGoogle Scholar4. Stedman's Medical Dictionary, 25th ed. Baltimore: Williams & Wilkins;1990. Google Scholar5. KregerCravenMcCabe BDW. Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med. 1980;68:344-55. CrossrefMedlineGoogle Scholar6. ParkerParrillo MJ. Septic shock. Hemodynamics and pathogenesis. JAMA. 1983;250:3324-7. CrossrefMedlineGoogle Scholar7. KnausDraperWagnerZimmerman WEDJ. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818-29. CrossrefMedlineGoogle Scholar8. BellCoalsonSmithJohanson RJJW. Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Intern Med. 1983;99:293-8. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Roger C. 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Parrillo, MDSeptic shock: pathogenesisDelirium with SepsisCharles E. Schwartz, MDInterférences avec la cascade immuno-inflammatoire 15 February 1991Volume 114, Issue 4Page: 332-333KeywordsBacteremiaBoneInterleukinsSepsisShock ePublished: 1 December 2008 Issue Published: 15 February 1991 PDF downloadLoading ...