The authors may also inform about any other difference in this group of patients.Authors’ responseJordi Rello and Alejandro inhibitor DAPT secretase Rodr��guez, for the H1N1 SEMICYUC Working GroupWe appreciate the interest from Dr Alonso-Tarr��s and colleagues in our article and their insightful observations regarding management of severe influenza A (H1N1)v. We agree that several points about antiviral treatment should be clarified.Recent observational studies suggested that antiviral treatment started within 4 days after illness onset may reduce mortality among adult patients hospitalized with influenza [4] and may enhance viral load decrease and viral clearance [5]. In our study, no significant delay in the first dose of antiviral was observed in patients with comorbidities (6.5 �� 5.

0, median 6 days) versus those without comorbidities (4.5 �� 3.8, median 4 days) [2]. No differences were observed regarding the severity of illness (Acute Physiology and Chronic Health Evaluation II score, 12.9 �� 7.9 vs. 14.5 �� 5.9; P = 0.50), organ dysfunction (Sequential Organ Failure Assessment score, 6.9 �� 4.2 vs. 6.2 �� 2.0; P = 0.54) or mortality (26.7% vs. 23.5%; P = 0.98) between groups.In a recent multicenter observational study [6], however, receipt of antiviral drugs in <48 hours was the only variable associated with positive outcome. In our study, eight (25%) patients received antiviral therapy within 48 hours after onset of symptoms, and one patient died (12.5%) [2]. Delayed initiation of antiviral therapy (>48 hours) was associated with high risk of death (odds ratio = 2.90, 95% confidence interval = 0.

30 to 28.0) and a mortality of 29.7%.Whereas randomized controlled trials are warranted to prove clinical benefit of early antiviral therapy, current observations suggest that a delay in antiviral therapy may contribute to increase the viral load, to delay shedding and to complications. Prompt diagnosis and early antiviral prescription should therefore be considered in patients with influenza-like illness for 2009 pandemic influenza.AbbreviationsPCR: polymerase chain reaction; RT: reverse transcriptase.Competing interestsThe authors declare that they have no competing interests.NotesSee related research by Rello et al., http://ccforum.com/content/13/5/R148
Mean arterial blood pressure (MAP) is the driving force for microvascular blood flow and thus an important determinant of tissue perfusion [1]. In its current guidelines [2], the Surviving Sepsis Campaign recommends to maintain a minimum MAP of 65 mmHg in patients with severe sepsis and septic shock. Apart from physiologic Anacetrapib knowledge [1], there is weak evidence to support this recommendation.