A clinical trial of an intervention for sepsis in patients in Zambia, led by Vanderbilt investigators, topped the list of 2017 trials featured by the website The Bottom Line.
The Bottom Line summarizes and critiques what it considers landmark papers in critical care and emergency medicine — papers that shape the management of critically ill patients. The editors of the site are critical care or emergency physicians.
The editorial group rated the 36 published clinical trials from 2017 that had been featured on the site. They considered the importance of the clinical question, how “game-changing” they found the conclusion, and how the trial was conducted.
The Bottom Line ranked the sepsis trial led by Ben Andrews, MD of the Vanderbilt Institute for Global Health and the University of Zambia and Matthew Semler, MD, MSCI, assistant professor of Medicine at Vanderbilt, as the best critical care trial of 2017.
The trial, called SSSP2 (Simplified Severe Sepsis Protocol 2), tested the effect of an early resuscitation protocol — administration of intravenous fluids, blood pressure-raising medications and blood transfusions — on in-hospital mortality in adult patients presenting with sepsis and hypotension to an emergency department in Zambia.
The results, reported in the Journal of the American Medical Association, showed that contrary to expectations based on similar trials conducted in developed countries, the protocol for early resuscitation actually increased in-hospital mortality compared to usual care (management by the treating clinician).
The Bottom Line commended Andrews and colleagues for conducting well-designed research in a resource-poor country.
Douglas Heimburger, MD, professor of Medicine, and Gordon Bernard, MD, Melinda Owen Bass Professor of Medicine, also participated in the study.