Recombinant activated protein C usage in Scotland: a comparison with published guidelines and a survey of attitudes.

Severe sepsis is a common cause of admission to the intensive care unit and is associated with a high hospital mortality. This audit explored the current use of, and attitudes towards, recombinant activated protein C therapy across Scotland, and compared these with current guidance. Patients with severe sepsis were followed for three days. Consideration and/or usage of recombinant activated protein C were compared with two different guidelines. Ninety-seven patients were admitted to the intensive care unit over the audit period. Recombinant activated protein C was used in nine of these patients. Depending on the criteria used, between 50% and 81% of the patients who qualified for recombinant activated protein C therapy did not receive it. Subsequent to the audit, a survey was performed to study intensive care unit consultants' attitudes to recombinant activated protein C therapy. A total of 125 consultants responded to the survey (77%). Of these, 104 (83%) stated that they used recombinant activated protein C in their clinical practice, 56 (52%) of whom prescribed it to patients with two-organ failures and an Acute Physiology and Chronic Health Evaluation II score of ≥ 25. Thirty-nine respondents (38%) stated that two-organ failures alone would be an adequate trigger for therapy. We conclude that recombinant activated protein C is potentially under-used to treat severe sepsis. Many consultants seem to reserve the drug for the most severely ill sub group of patients.

The effects of reboxetine, a noradrenaline reuptake inhibitor, on the plasma noradrenaline response to a cold pressor test in healthy volunteers.

Previous studies have shown peripheral abnormalities in noradrenergic activity in depressed melancholic patients. These abnormalities have a relationship with short-term and long-term outcome. Little is known about the effects of antidepressant treatment on these peripheral measures such as plasma noradrenaline (NA) and the plasma NA response to a laboratory stressor, the cold pressor test (CPT). The present study examines the effects of the antidepressant reboxetine, a noradrenaline reuptake inhibitor, on baseline plasma NA and the plasma NA response to a CPT, in nine healthy volunteers compared to placebo. A double-blind crossover design was used, with each agent given for 4 weeks with a 4-week washout period. There was no effect of reboxetine on baseline plasma NA. The plasma NA response to reboxetine, with a CPT, was blunted 3 days after commencing treatment. Reboxetine alters the plasma NA response to a CPT independent of baseline plasma NA.