We read with interest the review article by Dr Baue1 in which he describes so clearly the problems with studies of new modulators of inflammation aimed at preventing systemic inflammatory response syndrome (SIRS) in patients in the intensive care unit, the limitations of single anti-inflammatory therapies, and the need for early identification of patients at risk.
He correctly points out the shortcomings of trials of powerful modulators of inflammation in patients with a wide variety of diseases and disease severity, and recommends more critical patient selection for inclusion in therapeutic trials. This includes "rapidly identifying circulating endotoxin (by a lipopolysaccharide assay), Gram-negative bacteremia (by rapid culture techniques), and . . . elevated mediator levels, such as interleukin 6 or TNF [tumor necrosis factor]. . . ." However, because individual mediator levels change rapidly and have overlapping functions, even if rapid bedside patient measurement were possible, it may not identify those patients at risk of SIRS.