One of the investigators (SS) made daily rounds in the medical ICU to identify eligible patients. Patients who were entered into the study were prospectively followed up until they were discharged from the hospital or had died. Discharge from the hospital was defined as patient transfer from the hospital to home, to a skilled nursing facility, or to a private rehabilitative hospital. All patients suspected of having a microbiologically confirmed infection were prospectively and independently reviewed by a board-certified infectious disease physician (VJF) to confirm the diagnosis and the adequacy of the prescribed antimicrobial therapy using the criteria described below. Patients could not be entered into the study more than once during the same hospitalization.

All definitions were selected prospectively as part of the original study design. We calculated APACHE II scores on the basis of the clinical data available from the first 24-h period of intensive care. Canadian viagra shop The definition used for severe sepsis was the one proposed by the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. The Organ System Failure Index was modified from that used by Rubin and coworkers. One point was given for acquired dysfunction of each organ system. Renal dysfunction was defined as a twofold increase in baseline creatinine level or an absolute increase in baseline creatinine level of 176.8 pmol/L (ie, 2.0 mg/dL). Hepatic dysfunction Viagra pharmacy Canada was defined as an increase in total bilirubin level to > 34.2 pmol/L (ie, 2.0 mg/dL). Pulmonary dysfunction was defined as one of the following:

(1) a requirement for mechanical ventilation for a diagnosis of pneumonia, COPD, asthma, or pulmonary edema (cardiogenic or noncardiogenic);

(2) a Pao2 of < 60 mm Hg while receiving a fraction of inspired oxygen of > 0.50;

(3) the use of at least 10 cm H2O of positive end-expiratory pressure, hematologic dysfunction, the presence of disseminated intravascular coagulation, a leukocyte count of < 1,000 cells/pL (ie, 1.0 X 109 cells/L) or a platelet count of < 75 X 103 cells/pL (ie, 75 X 109 cells/L), neurologic dysfunction, a new focal deficit (eg, hemiparesis after cerebral infarction) or a new generalized process (eg, seizures or coma), GI dysfunction, GI hemorrhage requiring transfusion, or new ileus or diarrhea lasting for > 24 h and unrelated to previous bowel surgery. Cardiac dysfunction was defined as acute myocardial infarction, cardiac arrest, or the new onset of congestive heart failure.

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