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Sepsis is the leading cause of death in hospitals. It's a reaction to infection. Sometimes it's called blood poisoning. People who get fast and aggressive treatment are more likely to survive. That observation has prompted a few states to require specific steps for the condition, but those guidelines may not dictate the best possible treatment. NPR's Richard Harris reports.
RICHARD HARRIS, BYLINE: Treating a complicated condition like sepsis is, well, complicated. So doctors and medical societies develop guidelines to help highlight the current consensus. In 2013, New York state turned those voluntary guidelines into actual regulations that doctors must follow. Howard Zucker, commissioner of the New York State Health Department, says one point is key.
HOWARD ZUCKER: Intervention has to be quick.
HARRIS: Antibiotics and fluids are given at the first signs of trouble. Dr. Zucker knows what happens when that doesn't happen. In fact, he says, he has a cousin who has been struggling to recover from a severe bout of sepsis - hospitalized in another state, he adds.
ZUCKER: The health officials didn't ask the question, could this be sepsis? And then as the hours ticked by and symptoms progressed, then suddenly it was, oh, maybe this is sepsis. That's what we're trying to address. We want to have people intervene quickly. That's the regulations.
HARRIS: Early intervention is saving lives, though sepsis still kills about a quarter of the people who develop a serious case. And Dr. Jeremy Kahn at the University of Pittsburgh has mixed feelings about regulations. On the plus side, they do encourage doctors to act.
JEREMY KAHN: If we were great at doing the right thing, the thing that most people agree on, then we wouldn't need regulation.
HARRIS: But Kahn says doctors don't all keep up with the latest, best practices and follow them.
KAHN: The downside is that a regulatory approach lacks flexibility, and it essentially is saying that we can take a one-size-fits-all approach to treating a complex disease like sepsis.
HARRIS: And that's a problem because doctors haven't found the best way to treat this condition.
KAHN: The evidence is not only not ironclad, but it's rapidly shifting. Almost every day, there's - a new study is released that shows that what we thought to be best practice might not be best practice.
HARRIS: For a while, the practice guidelines called on doctors to use one particular drug to treat sepsis. It turned out that drug did more harm than good. And now a study presented at the American Thoracic Society and published in The New England Journal of Medicine finds that one of the required steps in New York may not in fact be beneficial. Christopher Seymour, a critical care physician at the University of Pittsburgh, says this has to do with intravenous fluids. The current regulations call for a rapid and substantial infusion.
CHRISTOPHER SEYMOUR: But what we haven't learned is the specific type of fluid to give patients, how much and how fast of a rate. And it's been quite controversial.
HARRIS: Seymour's data, based on the experience in New York state since the new regulations took effect, found that an early dose of fluids didn't actually help.
SEYMOUR: There are consequences and adverse effects that can come from too much fluid. And as a result, there's been great interest in this early phase of care and understanding the timing and the volume.
HARRIS: In fact, some doctors believe that most patients would be better off without this aggressive fluid treatment. There's a study getting under way to answer that question, but that will take years. So right now, it's a judgment call, Kahn says.
KAHN: So it is possible that at present they are requiring hospitals to adopt protocols for fluid resuscitation that might not be entirely appropriate.
HARRIS: It's also possible that there are other big changes on the horizon for treating sepsis. Doctors scattered coast to coast are trying a new protocol that, in addition to limiting fluids, uses high doses of vitamin C, steroids and vitamin B1. that has generated a great deal of enthusiasm. It remains to be seen if it is indeed an exciting advance or another disappointment.
ZUCKER: If there is a disruptive technology that comes out or a therapy that comes out, we would adjust accordingly.
HARRIS: Zucker at the New York State Health Department says the current regulations would not stand in the way. Richard Harris, NPR News.
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