The role of vagus nerve stimulation in sepsis

Sepsis is a life-threatening organ dysfunction due to a dysregulated host response to infection. The infection triggers a host response with an early hyperinflammatory and subsequent anti-inflammatory phase, both regulated by homeostatic mechanisms. A breakdown of these regulatory mechanisms can result in an exaggerated immune response which leads to complications. The vagus nerve plays a central role in regulating inflammation and the balance between the sympathetic and parasympathetic arms of the autonomic nervous system through the “cholinergic anti-inflammatory pathway”. Several experimental models support the notion that external stimulation of the vagus nerve can modulate inflammation and restore the sympatho-vagal balance which may translate to improved outcomes in sepsis. Here, we review the pathophysiologic basis and evidence behind vagus nerve stimulation in sepsis.