Paper reports overview Sepsis, insulin and noninvasive ventilation 英文参考文献.docVIP

Available online /content/6/1/093 Paper reports Synopses of recently published research relevant to intensivists 6 November 2001 – 8 January 2002 Overview Sepsis, insulin and noninvasive ventilation Richard Venn Critical Care 2002, 6:93-94 The paper reports presented here reflect the current leading issues in the intensive care literature, the search for the ‘magic bullet’ in sepsis being an obvious example. Many of the trials in sepsis that are currently being reported were presented at recent conferences [1]. This is the case for the KyperSept Antithrombin III Study (see paper report) [2]. The summary of this paper highlights the disappointment of the study: “ATIII [antithrombin III] joins a long list of promising experimental agents for sepsis that failed to show a significant benefit in a multicentre, randomised phase III clinical trial.” pressure ventilation. Not surprisingly, the need for extubation was significantly higher in the control group, as was hospital and 120-day mortality. It would be interesting to know whether this mortality benefit remained significant if the randomization had been to nonintermittent positive pressure ventilation versus invasive ventilation. Hormone therapy has always been popular in the critically ill, and one report [7] investigated intensive insulin therapy in non- diabetic surgical and critically ill patients. Crude hospital mor- tality was 7.2% in the intensive therapy group versus 10.9% in the control group (P = 0.01), and this benefit was associated with a 46% reduction in bloodstream infections. Although some success has been reported with ‘magic bullet’ studies [3], the paper by Rivers and colleagues (see paper report) [4] puts these to shame by demonstrating a superlative outcome benefit with essentially good early resuscitative care in severe sepsis and septic shock. Goal-directed therapy in the emergency department for patients