CJIDMM Canadian Journal of Infectious Diseases 1180-2332 Pulsus Group Inc 916317 10.1155/2002/916317 Original Article Guidance on patient Identification and Administration of Recombinant Human Activated protein C for the Treatment of Severe Sepsis Garber Gary ggarber@ottawahospital.on.ca 1 Gibney RT Noel 2 Light Bruce 3 Martin Claudio 4 Cunningham Kenneth 5 Guimond Jean-Gilles 6 Magder Sheldon 7 Russell James 8 1 Department of Medicine University of Ottawa Ottawa, Ontario Canada uottawa.ca 2 Division of Critical Care Medicine University of Alberta Edmonton, Alberta Canada ualberta.ca 3 Medicine and Medical Microbiology University of Manitoba and St Boniface General Hospital Winnipeg, Manitoba Canada umanitoba.ca 4 University of Western Ontario and London Health Sciences Center London Ontario Canada uwo.ca 5 Department of Medicine and Critical Care Lion’s Gate Hospital Vancouver, British Columbia Canada lghfoundation.com 6 Department of Medicine Université de Montréal CHUM Montreal, Quebec Canada umontreal.ca 7 Department of Medicine McGill University and Royal Victoria Hospital Montreal, Quebec Canada mcgill.ca 8 Department of Medicine University of British Columbia and St Paul’s Hospital Vancouver, British Columbia Canada ubc.ca 2002 1 12 2002 13 6 361 372 10 5 2002 16 8 2002 2002 Copyright © 2002 Hindawi publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Approximately one-third of cases of severe sepsis result in death. Endogenous activated protein C (ApC) plays a key role in the regulation of the inflammation, fibrinolysis and coagulation associated with severe sepsis. In a recently published phase III trial, protein C Worldwide Evaluation in Severe Sepsis (pROWESS), intravenous administration of recombinant human ApC (rhApC) 24 µg/kg/h for 96 h to patients with severe sepsis resulted in a 6.1% reduction in absolute mortality and a 19.4% reduction in the relative risk of death from any cause within 28 days (number needed to treat = 16). This dose is now being applied in clinical practice.

rhApC is recommended for the treatment of severe sepsis (sepsis associated with acute organ dysfunction) occurring as a result of all types of infection (Gram-negative bacterial, Gram-positive bacterial and fungal). A panel of Canadian clinicians experienced in the treatment of severe sepsis and the management of critical care patients has developed this consensus document to assist clinicians in appropriate patient selection and management of potential challenges associated with rhApC therapy.

 Coagulation Recombinant human activated protein C Sepsis Septic shock