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June 17, 2009

International Differences in the Treatment of SepsisAre They Justified?

Author Affiliations

Author Affiliations: The Clinical Research Investigation and Systems Modeling of Acute illness (CRISMA) Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Kellum); and Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan (Dr Uchino).

JAMA. 2009;301(23):2496-2497. doi:10.1001/jama.2009.850

Imagine a patient with acute coronary syndrome on a flight from New York to Tokyo. Given how small the world of medicine has become, it is reasonable to assume that the treatment he/she would receive would be very similar no matter if the plane returned to New York or continued to Tokyo. Now imagine that the patient had septic shock instead of heart disease—landing in New York or Tokyo would result in drastically different treatment. In New York, early goal-directed therapy (EGDT) and drotrecogin alfa are widely used while the former is less common and the latter is unavailable in Tokyo. Conversely, for more than 10 years, a patient with sepsis would likely receive therapy with an endotoxin adsorber (polymyxin B hemoperfusion) in Tokyo, a treatment unavailable in New York.

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