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Báo cáo khoa học: "Recently published papers: Curing, caring and follow-up"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Recently published papers: Curing, caring and follow-up. | Available online http ccforum.eom content 7 5 339 Commentary Recently published papers Curing caring and follow-up Gareth Williams Consultant in Anaesthesia and Critical Care University Hospitals of Leicester Leicester Royal Infirmary Leicester UK Correspondence Gareth Williams garethdavidwilliams@tiscali.co.uk Published online 2 September 2003 Critical Care 2003 7 339-341 DOI 10.1186 cc2381 This article is online at http ccforum.com content 7 5 339 2003 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Ups and downs in the fight against sepsis Sepsis is a major cause of critical illness with a mortality rate in the range of 30-50 . Two landmark papers have been published in the past 18 months that have significantly furthered our ability to manage sepsis and to reduce the high mortality rate associated with it 1 2 . The future seemed brighter. Following the success of the activated protein C trial in 2001 1 interest in anticoagulant therapy for severe sepsis was heightened. A systemic imbalance between procoagulant and anticoagulant pathways exists in severe sepsis leading to thrombus formation in the microvasculature and to subsequent end-organ injury. Endothelial injury occurring in severe sepsis is thought to be a trigger for this process initiating the clotting cascade via the transmembrane receptor known as tissue factor and its interaction with factor VII. Inhibition of this interaction would block the coagulation pathway at its earliest point. With this concept in mind July witnessed the publication of a large multicentre phase 3 randomised double-blind placebo-controlled clinical trial investigating the efficacy and safety of recombinant tissue factor pathway inhibitor TFPI in severe sepsis 3 . Two subgroups of patients were randomised to either a 96-hour infusion of active drug or to placebo a high International Normalised Ratio INR group INR 1.2 1754 patients and a low INR group INR 1.2 201 patients . The study failed to demonstrate any .