Advertisement

Featured in NEJM Journal Watch: Studies Point to Shift in Sepsis Treatment — Physician’s First Watch

Medical News |
March 18, 2014

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)

Joanne Rink, MD Physician, Surgery, General, Garden City, KS

Is there any way to focus content to specialty?

Prof. Pinchas Halpern Physician, Emergency Medicine, Tel Aviv Medical Center

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.

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Enter the characters shown in the image.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.

Advertisement
Advertisement
Advertisement