Table 7.

Summary of the five interventions and recommendations of the panel on clinical application of each

Intervention	Patient population studied	Timing of intervention	Recommendations of the panel
Low tidal volume	ALI/ARDS patients fulfilling blood gas criteria and with bilateral infiltrates	Evidence of ALI/ARDS. Earlier application warranted in patients with sepsis likely to develop ALI/ARDS	Tidal volume should be limited to ~6 ml/kg in patients with ALI/ARDS requiring mechanical ventilation
Early goal-directed therapy	Emergency room patients with two out of the four SIRS criteria and systolic blood pressure ≤ 90 mmHg or lactate ≥ 4 mmol/l	Pre entry into the ICU	Severe sepsis and septic shock patients should receive early aggressive hemodynamic therapy, and fluids and inotropic agents where indicated
Drotrecogin alfa (activated)	Severe sepsis patients as defined by three or more SIRS criteria plus at least one acute organ dysfunction	Within 48 hours of diagnosis of the most recent organ dysfunction	Patients with severe sepsis and high risk of death (e.g. APACHE II score ≥ 25, or two or more organ dysfunctions)
Moderate-dose corticosteroids	Refractory septic shock	As soon as refractory septic shock develops	Administer to refractory septic shock patients, particularly those with relative adrenal insufficiency, after an ACTH test has been carried out
Tight control of blood sugar	Mostly surgery patients with SIRS or sepsis	ICU admission	Tightly control blood sugar close to physiologic levels

ACTH, adrenocorticotrophic hormone; ALI, acute lung injury; APACHE II, Acute Physiology and Chronic Health Evaluation II; ARDS, acute respiratory distress syndrome; ICU, intensive care unit; SIRS, systemic inflammatory response syndrome.