Among patients with very severe ARDS, 60-day mortality was not significantly lower with ECMO than with a strategy of conventional mechanical ventilation that included ECMO as rescue therapy. (Funded by the Direction de la Recherche Clinique et du Développement and the French Ministry of Health; EOLIA ClinicalTrials.gov number, NCT01470703 .).

EVERE SEPSIS REMAINS AN IMPORtant cause of death, accounting for 9.3% of all deaths in the United States in 1995. 1 If our understanding of the mechanisms of host response to stress has strongly progressed during the last 2 decades, 2 the various drugs developed for specific targets of the cytokine cascade have failed to improve patient survival. 3,4 Corticosteroids were the first antiinflammatory drugs tested in randomized trials. At high doses during short courses, they did not induce favorable effects. 5,6 However, the observation that severe sepsis may be associated with relative adrenal insufficiency 7,8 or systemic inflammation-induced glucocorticoid receptor resistance 9 prompted renewed interest of a replacement therapy

In this trial involving patients with septic shock, 90-day all-cause mortality was lower among those who received hydrocortisone plus fludrocortisone than among those who received placebo. (Funded by Programme Hospitalier de Recherche Clinique 2007 of the French Ministry of Social Affairs and Health; APROCCHSS ClinicalTrials.gov number, NCT00625209 .).

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Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency.

Transfusion of fresh red cells, as compared with standard-issue red cells, did not decrease the 90-day mortality among critically ill adults. (Funded by the Canadian Institutes of Health Research and others; Current Controlled Trials number, ISRCTN44878718.).

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