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University of Pittsburgh researchers question treatment of septic shock

Luis Fábregas
| Tuesday, March 18, 2014, 6:35 a.m.

More aggressive treatment is not necessarily better for thousands of patients who suffer from septic shock each year, University of Pittsburgh researchers reported on Tuesday in the New England Journal of Medicine.

The findings could alter the way doctors treat this dangerous condition, which kills more people than heart attacks, strokes and trauma combined, the researchers said. Yet prompt evaluation and early treatment remain critical in dealing with sepsis, which develops when the body fights severe infections such as pneumonia.

“This is a disease that people often don't think about, yet it's very deadly,” said Dr. Donald Yealy, chief of emergency medicine at Pitt's School of Medicine. “It often creeps up on you.”

Doctors traditionally treat sepsis by giving patients intravenous fluids and antibiotics to attack the infection. They often opt for more aggressive treatment that includes placing a central line in the chest and giving blood transfusions. The central lines can lead to complications such as infections.

“This study will put the brakes on efforts to mandate that every patient with septic shock gets a central line,” said Dr. Derek Angus, chair of critical care medicine at Pitt and investigator of the study.

Using central lines and other invasive treatment did not improve outcomes among the study's 1,341 participants. The researchers reported that mortality rates for three types of interventions they studied was roughly the same, at about 20 percent.

Sepsis was far deadlier decades ago, mostly because its symptoms present themselves without warning, Angus said.

“The big problem for severe sepsis is that the onset can be far more insidious, and clinicians don't necessarily know that the patient was in trouble until the patient was gravely ill,” Angus said.

Roughly two-thirds of 750,000 people diagnosed with sepsis every year sought care in an emergency department, Yealy said.

“The key is to recognize it early and treat it early,” he said.

Sepsis commonly afflicts older people but is not exclusive to the elderly. A typical patient is battling pneumonia or a urinary tract infection, Yealy said.

The five-year study evolved after a 2001 study in which a Detroit hospital found death rates among sepsis patients dropped by 16 percent with a treatment protocol that included the use of central lines. That study prompted three international trials; Pitt's is the first to be published, said Sarah Dunsmore, program director at the National Institute of General Medical Sciences. The institute provided an $8.4 million grant for the study.

“This study is a real win for the patients,” Dunsmore said. “If you're taken to the emergency room, you can have peace of mind about sepsis.”

Angus said more aggressive treatment means higher cost of care. Ultimately, it is important for doctors and patients to be vigilant about the disease, he said.

“We would not want people relaxing their guard,” he said.

In addition to patients at UPMC Presbyterian and Shadyside, study participants included patients at Allegheny General Hospital.

Luis Fábregas is Trib Total Media's medical editor. He can be reached at 412-320-7998 or lfabregas@tribweb.com.

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