全身炎癥反應(yīng)綜合癥與膿毒血癥（下）(文件)
【正文】 70 80 90 100 Days from Start of Infusion to Death Percent Survivors P=.006 (stratified logrank test) 0 Placebo (n=840) Drotrecogin alfa (activated) (n=850) Drotrecogin Alfa (Activated) Significantly Reduced Mortality in PROWESS 6% Absolute mortality difference Administration of DrotAA in Early Stage Severe Sepsis (ADDRESS) ? International, randomized, placebocontrolled study to evaluate the efficacy of DrotAA for adults with severe sepsis and low risk of death ? APACHE II 25 or singlean failure ? N=2640 patients ? Trial terminated early because of a projected lack of effect Abraham E, et al. NEJM 20xx。345:135967 Van den Berghe, G. et al. N Engl J Med 20xx。354:449461 Intensive Insulin Therapy in the ICU ? Intensive insulin therapy significantly reduced morbidity but not mortality among all patients in the medical ICU ? Although the risk of subsequent death and disease was reduced in patients treated for 3 or more days, these patients could not be identified before therapy Van den Berghe, G. et al. N Engl J Med 20xx。因此，一是要了解器官的細(xì)菌易感性、抗藥性及醫(yī)院的環(huán)境（抗生素應(yīng)用所致）的影響，二是必須先選擇廣譜抗生素，再在細(xì)菌學(xué)的指導(dǎo)下過渡到窄譜抗生素。研究發(fā)現(xiàn)，以經(jīng)驗(yàn)而選擇的抗生素有 30％～ 70％在后來(lái)培養(yǎng)的細(xì)菌菌落不能被覆蓋。354:449461 Van den Berghe, G. et al. N Engl J Med 20xx。353:13321341 ADDRESS Trial Serious Bleeding with rhAPC ? Clinical Trials: ? PROWESS (% vs. 2%, p=) ? ADDRESS (% vs. %, p=) ? ENHANCE (%) ? Registry studies report higher bleeding rates than RCTs ? Risk of bleeding in actual practice may be higher Mechanical Ventilation of SepsisInduced Acute Lung Injury (ALI/ARDS) Mechanical Ventilation of SepsisInduced ALI/ARDS ? Target tidal volume of 6 mL/kg (predicted) body weight (NEJM 20xx) Grade 1B ? Maintain plateau pressures 30 cm H2O Grade 1C ? Permissive hypercapnia may be require
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