NICE issues guidance on sepsis
http://www.100md.com
《英国医生杂志》
The National Institute for Clinical Excellence (NICE) has recommended in new guidance that patients with severe sepsis should be treated with drotrecogin alfa (activated) only under the supervision of intensive care specialists with experience in managing the condition.
NICE, which provides national guidance on treatments and care used by the NHS in England and Wales, recommended that intensive care units in NHS hospitals should define the clinical circumstances in which drotrecogin alfa (activated) is to be used and the training and experience of consultants who will be authorised to initiate and supervise its use.
Commenting on the guidance, Dr Saxon Ridley, a consultant in intensive care at Norfolk and Norwich University Hospital, Norwich, and president of the Intensive Care Society, said: "Drotrecogin alfa (activated) should be used under intensive care supervision, as part of a package of care which can best be provided in intensive care units. The drug is indicated for patients with severe sepsis with two or more organs failing, which means they require a high level of care to optimise outcomes from its use."
He added: "The unit costs of drotrecogin alfa (activated) are high, so it should not be used indiscriminately. However, in appropriate patients the absolute risk reduction in mortality is about 7%, so the number needed to treat is only about 14." There is a small risk of intracranial haemorrhage—1% to 2%—he added.
Around 21 000 cases of severe sepsis occur each year in England and Wales, accounting for an estimated 27% of admissions to intensive care units and 46% of all bed days in the units. Despite advances in critical care, mortality from severe sepsis, which results from an exaggerated response to infection, is estimated to be between 30% and 50%. Drotrecogin alfa (activated) is a genetically engineered form of human activated protein C, that helps to reduce blood clotting and inflammation and that is reduced in severe sepsis.
Other guidance published in the same week recommends the use of a combination of immunosuppressants, according to cost and side effects, after renal transplantation.
Basiliximab or daclizumab should be used for induction treatment (immediately after transplantation), with the cheapest being chosen. This should be used with a combination of other drugs, including a calcineurin inhibitor—tacrolimus or ciclosporin, depending on which is least likely to cause serious side effects.(Susan Mayor)
NICE, which provides national guidance on treatments and care used by the NHS in England and Wales, recommended that intensive care units in NHS hospitals should define the clinical circumstances in which drotrecogin alfa (activated) is to be used and the training and experience of consultants who will be authorised to initiate and supervise its use.
Commenting on the guidance, Dr Saxon Ridley, a consultant in intensive care at Norfolk and Norwich University Hospital, Norwich, and president of the Intensive Care Society, said: "Drotrecogin alfa (activated) should be used under intensive care supervision, as part of a package of care which can best be provided in intensive care units. The drug is indicated for patients with severe sepsis with two or more organs failing, which means they require a high level of care to optimise outcomes from its use."
He added: "The unit costs of drotrecogin alfa (activated) are high, so it should not be used indiscriminately. However, in appropriate patients the absolute risk reduction in mortality is about 7%, so the number needed to treat is only about 14." There is a small risk of intracranial haemorrhage—1% to 2%—he added.
Around 21 000 cases of severe sepsis occur each year in England and Wales, accounting for an estimated 27% of admissions to intensive care units and 46% of all bed days in the units. Despite advances in critical care, mortality from severe sepsis, which results from an exaggerated response to infection, is estimated to be between 30% and 50%. Drotrecogin alfa (activated) is a genetically engineered form of human activated protein C, that helps to reduce blood clotting and inflammation and that is reduced in severe sepsis.
Other guidance published in the same week recommends the use of a combination of immunosuppressants, according to cost and side effects, after renal transplantation.
Basiliximab or daclizumab should be used for induction treatment (immediately after transplantation), with the cheapest being chosen. This should be used with a combination of other drugs, including a calcineurin inhibitor—tacrolimus or ciclosporin, depending on which is least likely to cause serious side effects.(Susan Mayor)