Abstract: Exosomes are nanometer-sized membranous vesicles released by living cells. Exosomes are carriers of several active molecules such as nucleic acids, proteins and lipids, which can promote signal transmission between cells. Recent studies have shown that exosomes during sepsis are rich in cytokines and damage associated molecular patterns (DAMPs), which play important roles in promoting inflammation and mediating organ dysfunction during sepsis. This paper summarized the regulation mechanism of exosomes in sepsis and its roles in secondary multiple organ dysfunction.