Background Invasive fungal diseases (IFDs) remain important causes of morbidity and mortality. The consensus definitions of the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group have been of immense value to researchers who conduct clinical trials of antifungals, assess diagnostic tests, and undertake epidemiologic studies. However, their utility has not extended beyond patients with cancer or recipients of stem cell or solid organ transplants. With newer diagnostic techniques available, it was clear that an update of these definitions was essential. Methods To achieve this, 10 working groups looked closely at imaging, laboratory diagnosis, and special populations at risk of IFD. A final version of the manuscript was agreed upon after the groups’ findings were presented at a scientific symposium and after a 3-month period for public comment. There were several rounds of discussion before a final version of the manuscript was approved. Results There is no change in the classifications of “proven,” “probable,” and “possible” IFD, although the definition of “probable” has been expanded and the scope of the category “possible” has been diminished. The category of proven IFD can apply to any patient, regardless of whether the patient is immunocompromised. The probable and possible categories are proposed for immunocompromised patients only, except for endemic mycoses. Conclusions These updated definitions of IFDs should prove applicable in clinical, diagnostic, and epidemiologic research of a broader range of patients at high-risk.

EVERE SEPSIS REMAINS AN IMPORtant cause of death, accounting for 9.3% of all deaths in the United States in 1995. 1 If our understanding of the mechanisms of host response to stress has strongly progressed during the last 2 decades, 2 the various drugs developed for specific targets of the cytokine cascade have failed to improve patient survival. 3,4 Corticosteroids were the first antiinflammatory drugs tested in randomized trials. At high doses during short courses, they did not induce favorable effects. 5,6 However, the observation that severe sepsis may be associated with relative adrenal insufficiency 7,8 or systemic inflammation-induced glucocorticoid receptor resistance 9 prompted renewed interest of a replacement therapy

These guidelines identify the evidence base for best practices for family-centered care in the ICU. All recommendations were weak, highlighting the relative nascency of this field of research and the importance of future research to identify the most effective interventions to improve this important aspect of ICU care.