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New Research Could Lead to Reduced Deaths from Septic Shock
Vancouver, February 28, 2008 — New research by St. Paul’s Hospital’s Dr. Jim Russell and the team of Vasopressin and Septic Shock Trial (VASST) investigators – published in the latest edition of the prestigious New England Journal of Medicine – shows some patients with septic shock may have a better chance of surviving if they are treated with the human hormone vasopressin.
Sepsis is the body’s response to a severe infection and is a very serious medical condition characterized by an intense whole body inflammatory state. Dr. Russell’s research focused on patients suffering from septic shock, which leads to decreased tissue blood flow and oxygen delivery.
“Septic shock is the most common cause of death in intensive care units,” says Dr. Russell. “With a mortality rate of 40 to 60 per cent, it kills more people annually than heart attacks. Usual treatment includes antibiotics, fluids, oxygen, ventilator support and drugs to support low blood pressure such as the hormone norepinephrine. Our research found that infusion of the human hormone vasopressin could reduce the number of deaths in patients who have less severe septic shock.”
Although vasopressin is widely used to improve blood pressure in patients who have septic shock, no research had ever been done to determine whether vasopressin was more effective than norepinephrine in reducing deaths. The VASST study of 778 patients showed that vasopressin treatment did not change the primary outcome – death within 28 days - in those patients who were suffering from septic shock, but there was a demonstrable difference in patients who had less severe septic shock.
“In fact, our findings showed that in patients who had less severe septic shock, mortality was 26.5 per cent for the vasopressin treated group, compared to 35.7 per cent for the norepinephrine treated group,” said Dr. Russell.
There are about 750,000 cases per year of sepsis in the U.S. and about 75,000 in Canada. The number of cases is climbing around the world due to more resistant organisms, aggressive surgery and aging populations.
“This research provides more data for physicians and care teams that selective infusion of vasopressin in patients who have less severe septic shock has the potential to save the lives of thousands of septic patients,” said Dr. Russell. “Some experts recommend that a new trial of vasopressin in patients who have less severe septic shock is necessary to confidently determine whether vasopressin decreases their mortality.”
Dr. Jim Russell is a Professor of Medicine at University of British Columbia and a Principal Investigator at the James Hogg Centre for Cardiovascular and Pulmonary Research at St. Paul’s Hospital. He was previously Head of Medicine at St. Paul’s (1993 - 2003) and Head of Critical Care at UBC and St. Paul’s (1982 - 2005). The two major current themes of his research are: (1) the genomics of the systemic inflammatory response syndrome (SIRS) and sepsis; and (2) randomized controlled trials in the critically ill. The research success in sepsis was recognized in an invited review in New England Journal of Medicine (Russell JA. Management of Sepsis. N Engl J Med 2006; 355 (16): 699 – 713.)
St. Paul’s Hospital is a research, teaching and acute institution, operated by Providence Health Care. Providence is the largest faith-based health care organization in Canada, operating eight facilities in Vancouver, B.C., delivering compassionate care to 460,000 patients and residents each year, while training medical professionals and making innovative advances in research.
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