Care of patients with
sepsis has improved over the last decade. However, in the recent two years, there was no significant progress in the development of a new
drug for
critically ill patients. In January 2011, it was announced that the worldwide phase 3 randomized trial of a novel anti-Toll-like receptor-4 compound,
eritoran tetrasodium, had failed to demonstrate an improvement in the mortality of patients with
severe sepsis. In October 2011,
Xigris (drotrecogin alfa, a recombinant activated
protein C) was withdrawn from the market following the failure of its worldwide trial that had attempted to demonstrate improved outcome. These announcements were disappointing. The recent failure of 2 promising drugs to further reduce mortality suggests that new approaches are needed. A study was published showing that
sepsis can be associated to a state of immunosuppression and loss of immune function in human. However, the timing, incidence, and nature of the immunosuppression remain poorly characterized, especially in humans. This emphasizes the need for a better understanding of
sepsis as well as new therapeutic strategies. Many clinical experiences of the extracorporeal
membrane oxygenator (
ECMO) treatment for adult
acute respiratory distress syndrome (ARDS) patients, which is caused by the H1N1 influenza A virus, were reported. The use of ECMO in severe
respiratory failure, particularly in the treatment of adult ARDS, is occurring more commonly.