Also, surgical patients at low risk for death (single organ dysfunction) or with organ dysfunction not induced by sepsis should not be considered appropriate candidates for this therapy.
Single organ dysfunction and multiple organ dysfunction using vasopressin and norepinephrine were respectively: 37.7% vs. 49.2%, P = 0.02; and 17.8% vs. 26%; P = 0.05.
The futility of the study might have been driven by an adverse outcome in surgical patients with a single organ dysfunction, but the unfavorable outcome in surgical patients with a single organ dysfunction might not have been driven by lower severity per se, because a similar outcome was not observed in medical patients with a single organ dysfunction.
Also note a reduction in the incidence of single organ dysfunction (37.7% vs. 49.2%, respectively, P = 0.02) and multiple organ dysfunction using vasopressin and norepinephrine (17.8% vs. 26%, P = 0.05; P = 0.03).
DrotAA is not indicated for patients with single organ dysfunction and in particular should not be used in patients with single organ dysfunction and recent surgery.
ICU clinicians may be more knowledgeable and experienced in setting goals of life-sustaining therapies based on the reversibility of single organ dysfunction and on the presence of multiple organ failure.
However, in patients with a single organ dysfunction or APACHE II score of less than 20, no apparent survival benefit was found.
In the ADDRESS trial, patients with recent surgery and single organ dysfunction who received rhAPC had significantly higher 28-day mortality rates (20.7% versus 14.1%, p = 0.03, n = 635) [ 4].
Most of the initial cases of P. vivax associated ARDS were in returned travelers with single organ dysfunction and nonfatal outcome; however, more recent series from countries where P. vivax is endemic have reported ARDS cases with multiorgan dysfunction and considerable mortality (35, 36 ).
