October 1994

Invited Commentary

Author Affiliations

Louisville, Ky
Address correspondence to Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292 (Dr Polk).

Arch Surg. 1994;129(10):1042. doi:10.1001/archsurg.1994.01420340056009

The pursuit of an effective immune adjuvant or restorative therapy designed to decrease the risk of infection or death from sepsis has been a continued focus of basic and clinical research for the last 15 years. This has now progressed to specific interleukins, cytokines, and mediators, as well as their respective antagonists, all of which amplify the inflammatory response. The fundamental concept behind this route of inquiry recognizes the frequent final common pathway of many patients in modern surgical intensive care units: infection and related organ dysfunction. The goal of prophylaxis or therapy is to provide the little push over the hump that so many patients cannot overcome, with the expectation that survival would then be enhanced and hospital discharge hastened.

The statistical crucifixion that befell previous major endotoxin antibody clinical trials is well known.1 Extraordinarily expensive treatments were found to favorably alter outcome in various subsets of inevitably

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