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Format: 04/15/2014
Format: 04/15/2014

News

AGH Joins National Study Targeting Better Treatments for Sepsis and Septic Shock in Emergency Setting

Tuesday, June 7th, 2011

Difficult Conditions Claim as Many Lives as Heart Attack Annually in U.S.

Emergency medicine physicians at Allegheny General Hospital have joined a National Institutes of Health-sponsored study that could change the way sepsis and septic shock, which now have mortality rates as high as 50 percent, are treated in an emergency setting.

The ProCESS (Protocolized Care in Early Septic Shock) study is a 5-year, multicenter NIH-funded study of alternative strategies for treating septic shock, hypothesizing that there are “golden hours” when prompt, rigorous standardized care can improve outcomes for septic shock, a condition in which organs fail due to a severe infection.

“The results of this study will cause sweeping changes in the way we treat this disease,” said Arvind Venkat, MD, FACEP, Director of Research in the Department of Emergency Medicine at AGH. “Sepsis and septic shock are challenging disease processes that we need to get a better handle on. About as many Americans die of sepsis each year as die of a heart attack.”

The study aims to improve the management of septic shock by comparing two alternative treatment strategies: EGDT or Early Goal-Directed Therapy and PSC or Protocolized Standard Care, with the usual care offered by an attending physician in the emergency room.

A landmark 2001 paper established EGDT - which had been used for years in the intensive-care unit setting - as the standard of treatment in the emergency department for patients arriving with signs of severe sepsis or septic shock. The researchers found a dramatic improvement in mortality for these patients.

However, some physicians continued to question the EGDT strategy, Dr. Venkat said, arguing it was difficult and expensive to implement and that they did not, anecdotally, see a large drop in mortality rates. It also calls for interventions such as blood transfusions and the placement of a central venous catheter that can lead to other complications for the patient.

“More is not always better,” Dr. Venkat said. “Sometimes more can be worse.”

The study as a whole will involve about 1,900 patients; AGH, one of 29 study locations nationwide, hopes to enroll about 30. The study is expected to be complete in summer 2013.

Dr. Venkat and Michael Marynowski, DO, attending physician in emergency and internal medicine, are co-principal investigators at AGH. Marvin R. Balaan, MD, Interim Chief, Division of Pulmonary and Critical Care Medicine pulmonologist and critical care specialist, and Peter K. Linden, MD, Director of Critical Care Services for West Penn Allegheny Health System, are co-investigators.
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