{"id":32026,"date":"2014-07-23T12:18:29","date_gmt":"2014-07-23T11:18:29","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=32026"},"modified":"2014-07-23T12:48:28","modified_gmt":"2014-07-23T11:48:28","slug":"the-bmj-today-time-to-rethink-your-assumptions-about-sepsis-minerva","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2014\/07\/23\/the-bmj-today-time-to-rethink-your-assumptions-about-sepsis-minerva\/","title":{"rendered":"The BMJ Today: Time to rethink your assumptions about sepsis, Minerva"},"content":{"rendered":"

When I first arrived at the University of Bath, to study history and philosophy of science, our first lecture was about Sulis-Minerva:\u00a0the combination of Minerva, Roman goddess of wisdom, and Sulis, the Celtic goddess who lived in the hot springs that gave the city its name.\"Sulis_Minerva_head_Bath\"<\/a><\/p>\n

Sulis-Minerva became the goddess of health in Roman Britain, so it it seemed appropriate when working at The BMJ<\/em>\u00a0to ritually read her summary of the big journals<\/a> each week. The latest edition is called “The progression of rheumatoid arthritis and other stories<\/a>\u00a0. . .\u00a0” but it\u2019s the note about Chickenpox that makes this worth a read. The virus used to kill 100 US residents of all ages every year, but that number\u2019s dropped after concerted vaccination programmes. And, the fear that this may push the virus into older populations, where shingles is much more severe, hasn\u2019t manifested.<\/p>\n

Obviously, looking forward from Roman Britain, our health would seem miraculous. Yet\u00a0as we know more, it\u2019s important to \u201cchallenge our basic assumptions,\u201d says\u00a0Simon Brown in an Editorial<\/a> to accompany Patel et al\u2019s Research paper “Randomised trials of human albumin for adults with sepsis<\/a>.”<\/p>\n

Patel et al carried out a systematic review and meta-analysis to assess the efficacy and safety of pooled human albumin solutions as part of fluid volume expansion and resuscitation (with or without improvement of baseline hypoalbuminaemia) in critically unwell adults with sepsis of any severity. They conclude that, although there was no harm detected, the analysis does not support a recommendation for use.<\/p>\n

The paper\u00a0reminds us of the counter intuitive findings of the FEAST trial, which found that fluid resuscitation in Kenyan, Ugandan, and Tanzanian children with shock actually increased mortality (listen to Katheryn Maitland explain the background in this podcast interview<\/a>). Unlike the FEAST trial, Patel didn\u2019t find an increase in mortality in this study, although as Brown observes in his Editorial,\u00a0“it does give us a reason to question some basic assumptions about resuscitation in patients with sepsis.\u201d Brown also goes on to say:\u00a0\u201cthere is little justification for using human albumin rather than an isotonic crystalloid as a volume expander in patients with septic shock.\u201d<\/p>\n

If you\u2019re challenging your basic assumptions about sepsis, you may want go back to the beginning and read “On the Antiseptic Principle in the Practice of Surgery<\/a>” by Joseph Lister, published in The BMJ<\/em> (then still The British Medical Journal<\/em>) in 1867. Or, if you\u2019ve been waiting for the movie, we\u2019re happy to oblige.<\/p>\n