In this episode, which was recorded a few months ago, I discuss my trip to Japan and make some observations about emergency medicine as it exists in Japan compared to the United States. Pictured above are trainees in emergency medicine from the University of New Mexico and the Sendai City Hospital in Japan. I also talk about the HYPRESS trial – The Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis. This was a randomized placebo controlled clinical trial that examined whether corticosteroids help patients in septic shock. Bottom line, there was no benefit to using hydrocortisone over placebo in patients with septic shock.
Since I recorded the podcast and since the publication of the HYPRESS trial a more recent metaanalysis of randomized controlled trials was published in the journal Critical Care: Corticosteroids in septic shock: a systematic review and network meta-analysis
It concludes that corticosteroids can reverse shock (the observable findings of overwhelming infection) but they do not help survival. This is exactly what we would predict if the body’s response to overwhelming infection that comprise shock are high stakes host defenses that evolved by natural selection.
The ADRENAL trial will be reported on January 19th. You know how I think this will turn out. What do you think?
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Emergency Physician, Educator, Researcher, interested in the microbiome, evolution, and medicine