Back to basics in sepsis treatment: critically ill patients need intensive care

Marik and Bellomo reason that stress hyperglycemia might be an essential survival response [1]. We reviewed the same question in this journal, before multi-center studies on glycemic control were published [2]. It strikes us that of almost all novel therapies in septic patients, few appear to withstand time. If everything has been futile, did we cause iatrogenic damage, as suggested [1], and is there reason to become cynical? We think the original studies gave rise to good developments. First, the Rivers protocol led to the implementation of limited sepsis treatment bundles resulting in a mortality decrease. Second, the results and the glycemic control of studies by Greet van den Berghe appeared to be not that simple to achieve in real life. Third, lactate-guided therapy improved outcomes, although without an exactly known