In 2006, Critical Care provided important and clinically relevant research data in the field of multiple organ failure, sepsis, and shock. This review summarizes the results of the experimental studies and clinical trials and discusses them in the context of the relevant scientific and clinical background.

Anesteziologicko resuscitacni klinika Fakultni nemocnice u sv Anny Pekarska 53 656 00 Brno Czech Republic

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Payen D, Sablotzki A, Barie PS, Ramsay G, Lowry S, Williams M, Sarwat S, Northrup J, Toland P, McL Booth FV. International integrated database for the evaluation of severe sepsis and drotrecogin alfa (activated) therapy: analyses of efficacy and safety data in a large surgical cohort. Surgery. 2006;140:726–739. doi: 10.1016/j.surg.2006.06.009. PubMed DOI

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Choudhry MA, Bland KI, Chaudry IH. Gender and susceptibility to sepsis following trauma. Endocr Metab Immune Disord Drug Targets. 2006;6:127–135. PubMed

Oberbeck R, Dahlweid M, Koch R, van Griensven M, Emmendorfer A, Tscherne H, Pape HC. Dehydroepiandrosterone decreases mortality rate and improves cellular immune function during polymicrobial sepsis. Crit Care Med. 2001;29:380–384. doi: 10.1097/00003246-200102000-00029. PubMed DOI

Van Griensven M, Dahlweid FM, Giannoudis PV, Wittwer T, Bottcher F, Breddin M, Pape HC. Dehydroepiandrosterone (DHEA) modulates the activity and the expression of lymphocyte subpopulations induced by cecal ligation and puncture. Shock. 2002;18:445–449. doi: 10.1097/00024382-200211000-00010. PubMed DOI

Barkhausen T, Westphal B, Pütz C, Krettek C, van Griensven M. Dehydroepiandrosterone administration modulates endothelial and neutrophil adhesion molecule expression in vitro. Crit Care. 2006;10:R109. doi: 10.1186/cc4986. PubMed DOI PMC

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Ohwada A, Yoshioka Y, Iwabuchi K, Nagaoka I, Dambara T, Fukuchi Y. VEGF regulates the proliferation of acid-exposed alveolar lining epithelial cells. Thorax. 2003;58:328–332. doi: 10.1136/thorax.58.4.328. PubMed DOI PMC

Mura M, Han B, Andrade CF, Seth R, Hwang D, Waddell TK, Keshavjee S, Liu M. The early response of VEGF and its receptors during acute lung injury: implication of VEGF in alveolar epithelial cell survival. Crit Care. 2006;10:R130. doi: 10.1186/cc5042. PubMed DOI PMC

Medford ARL, Millar AB. Vascular endothelial growth factor (VEGF) in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS): paradox or paradigm? Thorax. 2006;61:621–626. doi: 10.1136/thx.2005.040204. PubMed DOI PMC

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Matot I, Weiniger CW, Zeira E, Galun E, Joshi BV, Jacobson KA. adenosine receptors and mitogen-activated protein A3 kinases in lung injury following in vivo reperfusion. Crit Care. 2006;10:R65. doi: 10.1186/cc4893. PubMed DOI PMC

Boulos M, Astiz ME, Barua RS, Osman M. Impaired mitochondrial function induced by serum from septic shock patients is attenuated by inhibition of nitric oxide synthase and poly(ADP-ribose) synthase. Crit Care Med. 2003;31:353–358. doi: 10.1097/01.CCM.0000050074.82486.B2. PubMed DOI

Brealey D, Brand M, Hargreaves I, Heales S, Land J, Smolenski R, Davies NA, Cooper CE, Singer M. Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet. 2002;360:219–223. doi: 10.1016/S0140-6736(02)09459-X. PubMed DOI

Crouser ED, Julian MW, Blaho DV, Pfeiffer DR. Endotoxin-induced mitochondrial damage correlates with impaired respiratory activity. Crit Care Med. 2002;30:276–284. doi: 10.1097/00003246-200202000-00002. PubMed DOI

Porta F, Takala J, Weikert C, Bracht H, Kolarova A, Lauterburg BH, Borotto E, Jakob SM. Effects of prolonged endotoxemia on liver, skeletal muscle and kidney mitochondrial function. Crit Care. 2006;10:R118. doi: 10.1186/cc5013. PubMed DOI PMC

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Krishnagopalan S, Kumar A, Parrilo JE, Kumar A. Myocardial dysfunction in the patient with sepsis. Curr Opin Crit Care. 2002;8:376–388. doi: 10.1097/00075198-200210000-00003. PubMed DOI

Rozenberg S, Besse S, Brisson H, Jozefowicz E, Kandoussi A, Mebazaa A, Riou B, Vallet B, Tavernier B. Endotoxin-induced myocardial dysfunction in senescent rats. Crit Care. 2006;10:R124. doi: 10.1186/cc5033. PubMed DOI PMC

Qing M, Wöltje M, Schumacher K, Sokalska M, Vazquez-Jimenez JF, Minkenberg R, Seghaye MC. The use of moderate hypothermia during cardiac surgery is associated with repression of tumour necrosis factory-α via inhibition of activating protein-1: an experimental study. Crit Care. 2006;10:R57. doi: 10.1186/cc4886. PubMed DOI PMC

Marik PE, Zaloga GP. Hypothermia and cytokines in septic shock. Norasept II Study Investigators. North American study of the safety and efficacy of murine monoclonal antibody to tumor necrosis factor for the treatment of septic shock. Intensive Care Med. 2000;26:716–721. doi: 10.1007/s001340051237. PubMed DOI

Scumpia PO, Sarcia PJ, Kelly KM, DeMarco VG, Skimming JW. Hypothermia induces anti-inflammatory cytokines and inhibits nitric oxide and myeloperoxidase-mediated damage in the hearts of endotoxemic rats. Chest. 2004;125:1483–1491. doi: 10.1378/chest.125.4.1483. PubMed DOI

Straub A, Breuer M, Wendel HP, Peter K, Dietz K, Ziemer G. Critical temperature ranges of hypothermia-induced platelet activation: possible implications for cooling patients in cardiac surgery. Thromb Haemost. 2007;97:608–616. PubMed

Lindenblatt N, Menger MD, Klar E, Vollmar B. Systemic hypothermia incerases PAI-1 expression and accelerates microvascular thrombus formation in endotoxemic mice. Crit Care. 2006;10:R148. doi: 10.1186/cc5074. PubMed DOI PMC

Giamarellos-Bourboulis EJ, Routsi C, Plachouras D, Markaki V, Raftogiannis M, Zervakis D, Koussoulas V, Orfanos S, Kotanidou A, Armaganidis A, et al. Early apoptosis of blood monocytes in the septic host: is it a mechanism of protection in the event of septic shock? Crit Care. 2006;10:R76. doi: 10.1186/cc4921. PubMed DOI PMC

Lemineur T, Deby-Dupont G, Preiser J-Ch. Biomarkers of oxidative stress in critically ill patients: what should be measured, when and how? Curr Opin Clin Nutr Metab Care. 2006;9:704–710. PubMed

Halliwell B, Whiteman M. Measuring reactive species and oxidative damage in vivo and in cell culture: how should you do it and what do the results mean? Br J Pharmacol. 2004;142:231–255. doi: 10.1038/sj.bjp.0705776. PubMed DOI PMC

Chuang C, Shiesh S, Chi C, Tu Y, Hor L, Shieh C, Chen M. Serum total antioxidant capacity reflects severity of illness in patients with severe sepsis. Crit Care. 2006;10:R36. doi: 10.1186/cc4826. PubMed DOI PMC

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Hauser B, Bracht H, Matejovic M, Radermacher P, Venkatesh B. Nitric oxide synthase inhibition in sepsis? Lessons learned from large-animal studies. Anesth Analg. 2005;101:488–498. doi: 10.1213/01.ANE.0000177117.80058.4D. PubMed DOI

O'Dwyer MJ, Dempsey F, Crowley V, Kelleher DP, McManus R, Ryan T. Septic shock is correlated with asymmetrical dimethyl arginine levels, which may be influenced by a polymorphism in the dimethylarginine dimethylaminohydrolase II gene: a prospective observational study. Crit Care. 2006;10:R139. doi: 10.1186/cc5053. PubMed DOI PMC

Prigent H, Maxime V, Annane D. Clinical review: corticotherapy in sepsis. Crit Care. 2004;8:122–129. doi: 10.1186/cc2374. PubMed DOI PMC

Salgado DR, Verdeal JCR, Rocco JR. Adrenal function testing in patients with septic shock. Crit Care. 2006;10:R149. doi: 10.1186/cc5077. PubMed DOI PMC

Arafah BM. Hypothalamic pituitary adrenal function during critical illness: limitation of current assessment methods. J Clin Endocrinol Metab. 2006;91:3725–3745. doi: 10.1210/jc.2006-0674. PubMed DOI

Eichacker PQ, Natanson C. Increasing evidence that the risks of rhAPC may outweigh its benefits. Intensive Care Med. 2007;33:396–399. doi: 10.1007/s00134-007-0556-8. PubMed DOI

Abraham E, Williams MD, Nelson DR, Laterre P, Bernard GR, Vincent JL. Baseline characteristics and placebo mortality of severe sepsis patients in the INDEPTH integrated database [abstract] Crit Care Med. 2003;31:A123. doi: 10.1097/01.CCM.0000053648.42884.89. DOI

Vincent JL, O'Brien J, Jr, Wheeler A, Wittebole X, Garg R, Trzaskoma BL, Sundin DP. Use of integrated clinical trial database to evaluate the effect of timing of drotrecogin alfa (activated) treatment in severe sepsis. Crit Care. 2006;10:R74. doi: 10.1186/cc4909. PubMed DOI PMC

Nguyen HB, Corbett SW, Steele R, Banta J, Clark RT, Hayes SR, Edwards J, Cho TW, Wittlake WA. Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Crit Care Med. 2007;35:1105–1112. doi: 10.1097/01.CCM.0000259463.33848.3D. PubMed DOI