August 2016

Sepsis experts: Important to test alternative drugs

Findings published today in JAMA show that vasopressin can be used as an alternative to typically used adrenaline-like drugs to improve blood pressure in septic shock.

Stephen Brett, President of Intensive Care Society and Co-Investigator on the study, says it is crucial to explore alternatives to the drug regime currently used for septic shock in intensive care; although currently used drugs have been used for a long time, many have side effects which can be unhelpful for some patients.

Sepsis is the body’s response to severe infection and is a life-threatening condition that in severe cases causes the blood pressure to fall dangerously, compromising blood flow to vital organs such as the liver and kidney (septic shock). In the UK alone more than 123,000 people are admitted to intensive care units due to sepsis.

High death rates with current practice

Despite advances in treatment around 36,800 of such patients unfortunately die. Experts agree that it is important to test alternative drug treatments.

Current practice is to treat all patients with antibiotics and powerful adrenaline-like drugs to support the heart and blood pressure. However, we know these adrenaline-like drugs have side-effects.

National Institute for Health Research (NIHR) funded Research Professor Anthony Gordon conducted the VANISH trial, which is also supported by the Intensive Care Foundation. The trial compared early vasopressin use to noradrenaline.

Although the use of vasopressin did not show an improvement in the main outcome measure of the trial, which was a combination of survival and duration of kidney failure, it did reduce the use of adrenaline-like drugs and fewer patients treated with vasopressin needed the support of kidney machines.

Personalised drug strategy

NIHR Research Professor Anthony Gordon, the Chief Investigator of the trial and Director of Research for the Intensive Care Foundation, said that “it is important for clinicians to know that they can use vasopressin early in septic shock and that for some patients it may prevent the need for dialysis”.  

“Looking forward we now need to investigate ways to rapidly identify those patients who will benefit most so that appropriate treatment can be started early”, he also said.  

Now experts call for more research on drug treatment in intensive care. “It is time to look at a more personalised drug strategy for patients with sepsis to allow clinicians to treat patients as individuals and both to improve their chances of survival and their long term recovery and health”, says Dr Brett.  

”This study forms an important part of our national research effort in this area. The Intensive Care Foundation has worked with patients, their families and the whole professional community to determine jointly our future research priorities”.