Abstract
Numbers of clinical trials have been performed to establish the standard therapy for severe sepsis in the recent years. However, many of them have reported the inconsistent results from which had ever reported: 1) Intensive insulin therapy –effectiveness for severe sepsis could not be proven in a randomized controlled study (RCT) named VISEP, so that it won't be recommended to control the glucose level in the normal range strictly. 2) Steroids–CORTICUS failed to show the effectiveness of physiologic dose of hydrocortisone on survival in septic shock patients. 3) Intravenous immunoglobulin–although SBITS, the only one large scale RCT did not show the benefit of intravenous immunoglobulin on survival, the following systemic reviews supported its efficacy. 4) Recombinant human activated protein C (rhAPC) –survival benefit was reported in a recent large scale database. However, the other systematic review reported the contradictive result. Its efficacy is still controversial, but since the bleeding tendency is significant, the use of rhAPC should be limited in the life-threatening severe sepsis. Further studies should be needed to address the above issues. In summary, we have to understand that some parts of the guideline are based on the inconsistent evidences, and further blush up is required.
