Estimate of the Carbon Footprint of the US Health Care Sector

gests that the differences between mortality rates may not decrease with time.We agree with Vincent that the initial resuscitation period is critical.However, it is inappropriate to conclude, in the absence of supporting evidence, that treatment in the next 24 hours is unlikely to make a difference.The large prior experience with this therapy must be considered.In a meta-analysis involving 1425 patients, 786 of 978 patients received more than 1 polymyxin B treatment. 6 We acknowledge Dr Kida's observation of the preponderance of gram-positive organisms in the polymyxin B group.It is unlikely that this is a significant confounder.More than one-third of all patients had multiple organisms.Patients with gram-positive isolates also had gram-negative organisms.We agree that, in the absence of endotoxin measurements, the observed effects cannot be directly attributed to endotoxin removal.However, this hypothesis is logical in this context and biologically plausible.