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American Journal of Critical Care. 2003;12: 518-524
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CE Article

Role of Activated Protein C in the Pathophysiology of Severe Sepsis

By Patricia Dettenmeier, RN, MSN(R), CS, ANP, Bridget Swindell, RN, Mary Stroud, RN, Nancy Arkins, RN and April Howard, RN, CCRN, CCRC. From the Division of Pulmonary, Critical Care, and Occupational Medicine, St. Louis University School of Medicine, St. Louis, Mo (PD), Division of Allergy, Critical Care, and Pulmonary Medicine, Vanderbilt University, Nashville, Tenn (BS, MS), Eli Lilly and Co, Indianapolis, Ind (NA), Section on Pulmonary/Critical Care Medicine, Wake-Forest University, Winston-Salem, NC (AH).

Sepsis is a complex syndrome that can lead to multiple organ failure and death. Severe sepsis has been associated with mortality rates ranging from 28% to 50% and is the most common cause of death in the noncardiac intensive care unit. Despite advances in both antibiotic therapy and supportive care, the mortality rate due to severe sepsis has remained fundamentally unchanged in the past several decades. With increased understanding of the pathophysiology of sepsis, particularly the intricate interplay between activation of coagulation and inflammation, novel therapeutic agents that may improve clinical outcomes are being researched and developed. The epidemiology, pathophysiology, and treatment of severe sepsis are reviewed. Also discussed are the recently published results from a multicenter, randomized, placebo-controlled phase 3 clinical trial of drotrecogin alfa (activated), a recombinant form of human activated protein C, in patients with severe sepsis. The nursing implications of this new approved therapy are discussed.

Notice to CE enrollees:
A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe components of the pathophysiology of sepsis.
  2. Identify current treatment recommendations for severe sepsis.
  3. Recognize the role of activated protein C in the treatment of sepsis.




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D. M. Kyles and J. Baltimore
Adjunctive Use of Plasmapheresis and Intravenous Immunoglobulin Therapy in Sepsis: A Case Report
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