Unresolved questions with the use of linezolid vs vancomycin for nosocomial pneumonia.

parameters indicative of blood loss would have been more reliable estimates of perioperative blood loss. These indicators should be considered as one of the primary outcome variables. Although transfusions may reflect bleeding, previous data 15,16 suggest that transfusing blood in cardiac surgery is behavioral rather than a response to blood loss. Re-operation (exploration for bleeding) in coronary bypass surgery cannot be used as a measure of drug-induced coagulopathy unless one completely excludes other causes for bleeding, ie, heparin-protamine activity, large-vessel bleeding, and overall patient coagulation status. Simple changes in preoperative, intraoperative, and postoperative hemoglobin and hematocrit values would help clarify their claims, although even these are confounded by volume changes. The patients selected in the study by Avorn et al 1 were those who had received Ն 3 U packed RBCs within 72 h after undergoing CABG procedure; all other CABG patients were control subjects. The higher comorbidity in the cases (HES group) may act as a confounder leading to higher transfusion rates as a result of lower transfusion thresholds for more severely ill patients. The editorial accompanying this study recommends a change in practice without convincing evidence. Lack of sufficient data should not be replaced with personal interpretation of study results. This invariably can be misleading to the medical community. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]). Large-dose hydroxy-ethyl starch 130/0.4 does not increase blood loss and transfusion requirements in coronary artery bypass surgery compared with hydroxyethyl starch 200/0.5 at recommended doses. A novel hydroxyethyl starch (Voluven) for effective perioperative plasma volume substitution in cardiac surgery. A prospective randomized study of hydroxyethyl starch, albumin, and lac-tated Ringer's solution as priming fluid for cardiopulmonary bypass. versus albumin for colloid infusion following cardiopulmo-nary bypass in patients undergoing myocardial revasculariza-tion. Albumin versus hy-droxyethyl starch in cardiopulmonary bypass surgery: a meta-analysis of postoperative bleeding. We believe several issues must still be addressed in the study by Wunderink et al (November 2003) 1 published in CHEST. First, it is very unlikely that only uncensored data were used, as mentioned under Fig 2, because not all of the patients died over the follow-up period. Moreover, the p value reported in the curves appears to have been based on a ␹ 2 test, as suggested by the statistical analysis section, whereas it should have been based on the log-rank test, which appropriately accounts for length …