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Featured in NEJM Journal Watch: Studies Point to Shift in Sepsis Treatment — Physician’s First Watch
Featured in NEJM Journal Watch: Studies Point to Shift in Sepsis Treatment
By the NEJM Journal Watch Editors
Three studies of septic shock call some current approaches into question, and a fourth points to a dramatic overall decrease in mortality.
One of three New England Journal of Medicine studies found that a higher mean arterial pressure target (80 to 85 mm Hg) was no more effective at improving mortality than the recommended target of at least 65 mm Hg. However, atrial fibrillation was more common with the higher target.
The second study found albumin administration did not improve survival at 28 and 90 days.
A third study showed that a resuscitation protocol of early goal-directed therapy was no better at improving mortality than less invasive strategies.
Commenting in NEJM Journal Watch, emergency medicine physician Ali S. Raja finds that the pressure target of at least 65 mm Hg is "still appropriate" and that albumin should not be in routine use. He says that early intervention is more likely to make a difference than invasive monitoring.
A fourth study, in JAMA, notes a drop in absolute mortality from septic shock in Australia and New Zealand over the past decade — from 35% to 18%.
Reader Comments (2)
The study indicating the importance of early intervention in sepsis per se as opposed to mandatory implementation of complex monitoring and dedicated teams, is critically important in empowering emerging medical systems, which may have been overwhelmed into inaction by the presumption, that unless they could summon the funding and capacity to follow EGDT edicts verbatim they were not doing any good.
The proof, clinically logical as it may long have been, that it is really only important for physicians to make an early diagnosis and have in place protocols ensuring mainly simple non-invasive monitoring of BP, urine output, serum pH and base excess, and the administration of appropriate antibiotics and appropriate (i.e. not excessive) amounts of IV fluids, is liberating and empowering and may actually improve sepsis mortality worldwide.