Sepsis in the ICU: who needs progress?

Excerpt

Sir: In his recent Clinical Commentary [1] Dr Mackenzie accumulates all possible reasons why drotrecogin alfa (activated) should not be used in critically ill patients. Any argument is employed to support his viewpoint—even that the product was not adequately blinded! Counterarguments are also used: I have never before heard that having fewer do-not-resuscitate (DNR) orders in the treatment group than in the placebo group is a problem; indeed, this is precisely what one hopes to see if an intervention is effective, as deaths are usually preceded by a DNR order in the ICU. Maybe the incidence of DNR orders should be considered as a secondary end-point in clinical trials! …