This review explores the role of exosomes in sepsis and inflammatory organ injury, highlighting their significance in intercellular communication and organ dysfunction. Exosomes, small extracellular vesicles, play a pivotal role in modulating immune responses, metabolic reprogramming, coagulopathy, and organ dysfunction. The review begins by providing an in-depth insight into exosome biogenesis and characterization, laying the groundwork for understanding their diverse functions. It then delves into the regulatory roles of exosomes in various immune cells, such as neutrophils, macrophages, dendritic cells, T cells, and B cells, emphasizing their impact on immune responses. Additionally, the review discusses the role of exosomes in metabolic alterations, coagulation cascade, and their dual role in the progression and resolution of sepsis. The potential of exosomes as biomarkers and therapeutic targets is also highlighted, underscoring their therapeutic promise in critical care settings. The review concludes by emphasizing the need for further research to uncover the full potential of exosome-based interventions in mitigating severe outcomes of sepsis.This review explores the role of exosomes in sepsis and inflammatory organ injury, highlighting their significance in intercellular communication and organ dysfunction. Exosomes, small extracellular vesicles, play a pivotal role in modulating immune responses, metabolic reprogramming, coagulopathy, and organ dysfunction. The review begins by providing an in-depth insight into exosome biogenesis and characterization, laying the groundwork for understanding their diverse functions. It then delves into the regulatory roles of exosomes in various immune cells, such as neutrophils, macrophages, dendritic cells, T cells, and B cells, emphasizing their impact on immune responses. Additionally, the review discusses the role of exosomes in metabolic alterations, coagulation cascade, and their dual role in the progression and resolution of sepsis. The potential of exosomes as biomarkers and therapeutic targets is also highlighted, underscoring their therapeutic promise in critical care settings. The review concludes by emphasizing the need for further research to uncover the full potential of exosome-based interventions in mitigating severe outcomes of sepsis.