Patient-Focused Sedation and Analgesia

We thank Dr. Barie and his colleagues for their interest in our data.1 It is satisfying to note that other investigators also have had a similar experience regarding the influence of nonpulmonary organ dysfunction and failure on outcome in patients with respiratory failure. Contrary to our findings, they have reported2 that hepatic dysfunction had a significant influence of patient mortality in the patients they studied. The study appears to have been conducted at a primarily surgical ICU. Unfortunately, we do not have access to the detailed methodology and results of the abstract cited by Barie et al2 in this regard. In another study on patients with ARDS who were managed at a surgical ICU, they found that the dysfunction of all nonpulmonary organs contributed to an adverse outcome. The difference in the quantum of contribution of individual organ dysfunction to overall mortality is perhaps, therefore, related to the variability in case mix at their ICU and ours. Additionally, we used sequential organ function assessment (or SOFA) scores, and they used multiple organ dysfunction (or MOD) scores. Some differences in findings could therefore also be explained by variations in the definitions used to describe and stratify individual organ dysfunction. Despite these minor differences, we concur with them regarding the importance of recognizing and managing nonpulmonary organ dysfunction in patients with respiratory failure.