International Differences in the Treatment of Sepsis
Are They Justified?
- John A. Kellum, MD;
- Shigehiko Uchino, MD
- Author Affiliations: The Clinical Research Investigation and Systems Modeling of Acute illness (CRISMA) Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Kellum); and Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan (Dr Uchino).
Since this article does not have an abstract, we have provided the first 150 words of the full text.
- KEYWORDS:
- DROTRECOGIN
- DRUG THERAPY
- ENDOTOXINS
- ETHICS, MEDICAL
- EVIDENCE-BASED MEDICINE
- HEMOPERFUSION
- JAPAN
- OUTCOME ASSESSMENT (HEALTH CARE)
- POLYMYXIN B
- SEPSIS
- UNITED STATES
- WORLD HEALTH
Imagine a patient with acute coronary syndrome on a flight from New York to Tokyo. Given how small the world of medicine has become, it is reasonable to assume that the treatment he/she would receive would be very similar no matter if the plane returned to New York or continued to Tokyo. Now imagine that the patient had septic shock instead of heart disease—landing in New York or Tokyo would result in drastically different treatment. In New York, early goal-directed therapy (EGDT) and drotrecogin alfa are widely used while the former is less common and the latter is unavailable in Tokyo. Conversely, for more than 10 years, a patient with sepsis would likely receive therapy with an endotoxin adsorber (polymyxin B hemoperfusion) in Tokyo, a treatment unavailable in New York.
Why such radical differences? Aren't physicians treating sepsis in Japan and the United States practicing evidence-based medicine? It turns out …
