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Lessons from evolutionary medicine for sepsis and critical care
Author(s) -
Alcock Joe
Publication year - 2017
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.31.1_supplement.95.2
Subject(s) - sepsis , medicine , surviving sepsis campaign , intensive care medicine , intensive care unit , randomized controlled trial , clinical trial , emergency department , dysfunctional family , emergency medicine , septic shock , severe sepsis , nursing , clinical psychology
Sepsis remains a leading cause of death, causing approximately 60,000 deaths yearly. Despite hundreds of clinical trials and billions of dollars, only one agent aimed specifically at sepsis was ever approved by the FDA. It was subsequently withdrawn from the market after it was shown to be ineffective. Despite this and similar failures, researchers continue to search for therapies aimed at blocking inflammation and other physiologic changes in sepsis. These approaches have failed to improve mortality in human sepsis in part because they overlook functional adaptations and evolved tradeoffs in sepsis physiology. We have followed a series of 160 patients with severe sepsis admitted to the intensive care unit at the University of New Mexico, with the aim of predicting mortality based on initial measures of lactate, glucose, and kidney function in sepsis. Many of these parameters, e.g. blood glucose, follow similar distributions in survivors as compared to non‐survivors. Recent randomized controlled trials aimed at normalizing these parameters have generally failed to improve survival. These lines of evidence indicate that many sepsis “abnormalities” are in fact adaptive, not dysfunctional. This presentation will give examples of how evolutionary and evidence‐based medicine can work in concert to produce better outcomes in sepsis and critical care. Support or Funding Information Valente Foundation and the University of New Mexico Department of Emergency Medicine