Major advances are occurring in healthcare, and critical care is no exception. For example, a drug now exists that works to treat severe sepsis, the leading cause of death in noncardiac intensive care units (ICUs) (Table 1). In 2001, the United States Food and Drug Administration approved the use of Xigris (drotrecogin alfa [activated], Eli Lilly and Co, Indianapolis, Ind), a recombinant form of human activated protein C, to reduce mortality in adult patients with severe sepsis (sepsis associated with acute organ dysfunction) who have a high risk of death (eg, as determined by the Acute Physiology and Chronic Health Evaluation [APACHE] II).

Xigris is the first drug shown to improve survival in severe sepsis. The Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) trial, which evaluated Xigris, was a large doubleblind, placebo-controlled, international study. Xigris treatment...

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