Recently published papers: small pieces of the puzzle and the long-term view

In this same period a number of long-awaited reports and important new studies have been published. The reports from the 2001 International Sepsis Definitions Conference [1], the January 2002 US National Heart, Lung and Blood Institute 'Future Research Directions in Acute Lung Injury' [2] and the 2002 Brussels roundtable "Surviving Intensive Care" [3] have all finally reached print. Although much contained within these 'stock takes' will be familiar, they serve as valuable and timely summaries. The only concern I have is that the delay in their publication negates some of the momentum that such expert panels should generate.To complement the deliberations of the Sepsis Definitions Conference, Martin and colleagues [4] reported on their major epidemiological study of sepsis in the USA conducted from 1979 to 2000. The overall picture presented confirms that the incidence has tripled but the mortality rate has fallen from 28% to 18% over the 22 years. The proportion of patients with any organ failure increased from 19% to 34%, whereas the average hospital stay fell from 17 to 12 days. White females appear to be the least vulnerable group. Given the study methodology and complexities surrounding the definition of sepsis, drawing detailed conclusions is problematic, but this study undoubtedly provides further evidence to support the enormous ongoing efforts to tackle this phenomenon.Against the background of the global epidemic of obesity, the impact of body mass index on the short-term outcomes of critical illness has been investigated by Tremblay and Bandi [5]. The large population studied was North American, with a median intensive care unit (ICU) stay of only 2 days. Fifty-six per cent of patients admitted to ICU were overweight (30%), obese (20%) or severely obese (6%). Unsurprisingly, the investigators found that being underweight (13%) was associated with excess mortality, but the overweight/obese/severely obese appeared to fair no worse than their normal (33%) co