Sepsis in the CIS

The Worldwide Intensivist is committed to providing an international view of critical care. We therefore welcome the contribution of our colleagues Drs Zhidkov and Klechikoff from the Commonwealth of Independent States (CIS), which illustrates the immense diversity of critical care around the world. From their paper, it appears that within the CIS, accepted therapy for critically ill patients with sepsis and multiple organ dysfunction is substantially different from current Western therapy. It is also clear that they have access to a large Russian literature that is not readily available in the West. This makes assessment of the biological and methodological aspects of their work extremely difficult. We note immediately that several potential criticisms can be levelled at this study. Perhaps the three most immediate are the retrospective nature of the study, the high mortality in the "standard therapy" group, and failure to provide internationally sanctioned benchmarks of illness severity (for example, APACHE II scores). These limitations of the study, especially the last-mentioned, render comparison with other published studies difficult. Despite these and other smaller reservations, we felt that it was worthwhile bringing this study to your attention for the following reasons:

  1. The study alerts us to the endeavours of at least some Russian physicians in the tricky area of sepsis combined with multiple organ dysfunction;
  2. It is conceivable that new insights into management of sepsis might arise from examination of alternative therapies, such as those presented in the paper;
  3. We hope that in our own small way, we might promote fruitful dialogue between physicians in the West and those from the CIS.

From an editorial perspective, our major concern is that Drs Zhidkov and Klechikoff are perhaps a shade too dogmatic in their assertion that the lower mortality shown in this retrospective study justifies the application of "extracorporeal detoxification methods", without further corroboration.

One of the benefits of electronic media is that, in contrast to print, integrated cross-referencing and criticism is easily implemented after publication. In this context, we would welcome constructive remarks from around the globe. We would be particularly interested in comment from other institutions within the CIS. If, for example, some kind (and suitably qualified) soul would take upon themselves the onerous task of summarising or reviewing portions of the Russian literature in English, we would be keen to publish such material electronically!