Sepsis: What even IS “usual care” now? – Jeremy Faust
Despite decades of research, there is little agreement on what sepsis is. Trials continue but without an agreed upon universal definition, researchers are at risk of comparing apples to oranges, leaving clinicians more confused than before. In many trials, the control group receives what is called “usual care”, but even that is a malleable concept. We will briefly look at what “usual care” has tended to mean in some of the major trials of this decade, and see what we can learn by the inclusion criteria by some of today‚ most anticipated trials in progress now, including ongoing trials assessing so-called metabolic sepsis resuscitation (hydrocortisone, Vitamin C, and thiamine) and the efficacy of early fluids versus early vasopressors (the “CLOVERS” trial).
Since 1991-1992, competing sepsis definitions have – with varying degrees of success – attempted to capture the difference between normal and abnormal host responses in order to help researchers and clinicians improve care. The most crucial basis of “usual care” in sepsis treatment is, simply, who is deemed fit to receive it.
Jeremy Samuel Faust, MD MS MA (@JeremyFaust), is an emergency physician at Brigham and Women’s Hospital and an instructor at Harvard Medical School. He completed residency training at Mount Sinai Hospital and Elmhurst Hospital Center in New York, after graduating from the Mount Sinai School of Medicine (MD, MS in Biomedical Sciences).
He is the cohost of FOAMcast, an award-winning podcast bridging core emergency medicine content with cutting-edge topics. He is a frequent contributor to Slate, and has published essays in the New York Times; The New York Daily News; Undark Magazine; The Harvard Health Blog; and Mother Jones. Editor-In-Chief, ACEP Now. He serves on the editorial board of the Annals of Emergency Medicine and ACEP Now, and has served as a content editor for the New England Journal of Medicine Resident 360 Series.
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