The current status of the therapeutic approach for severe sepsis in Japan and its comparison to the international guidelines

DOI 3 Citations 66 References
  • Iba Toshiaki
    Department of Emergency and Disaster Medicine, Juntendo University
  • Mayumi Toshihiko
    Department of Emergency and Critical Care Medicine, Nagoya University
  • Ogura Shinji
    Department of Emergency and Disaster Medicine, Gifu University
  • Ishikura Hiroyasu
    Department of Emergency and Critical Care Medicine, Fukuoka University
  • Kotani Jyoji
    Department of Emergency and Disaster Medicine, Hyogo Medical School
  • Matsuda Naoyuki
    Department of Primary Care and Emergency Medicine, Kyoto University
  • Yokota Hiroyuki
    Department of Emergency Medicine and Critical Care, Nihon Medical School

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Other Title
  • 重症セプシス治療に関する本邦の現状と国際的ガイドラインとの比較

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Abstract

Both Intensive Insulin Therapy (IIT) and the low-dose hydrocortisone administration for septic shock are the hot stocks in the Surviving Sepsis Campaign guidelines 2004. However, the questions have occurred along with the accumulation of the recent evidences, and the recommendation levels for these treatments had been withdrawn. In contrast, although not included in the international guidelines, the treatments such as the direct-hemoperfusion with polymyxin B-immobilized column (PMX-DHP), anticoagulant therapy for disseminated intravascular coagulation (DIC) and sivelestat sodium for acute respiratory distress syndrome (ARDS), which are widely applied in Japan, attracts attention. Indeed, there are some significant differences in the therapeutic strategies for severe sepsis between Japan and other advanced countries. With regard to the PMX-DHP, although it has been ignored in the other countries, the recent randomized controlled study (RCT) performed in Italy proved its efficacy. Antithrombin was recommended not to administrate in DIC patients in the European guideline, while its administration is recommended in Japanese one. The efficacy of sivelestat sodium was proven again in the post-marketing surveillance performed in Japan, after the contrastive results from USA. Under these confusing situations, we clinicians must realize that the evidences for severe sepsis are quite unstable. There should not be any doubt for the importance of the evidence based medicine, however, we should recognize the differences of the genetics, health care systems and the historic backgrounds as well, and when we apply the certain treatment to the patients, we must consider not only the clinical evidences but also follow the individual experiences and the scientific knowledge. Actually, we think that the tailor-made medicine is just required for treatment of severe sepsis, and the uniform guideline treatment is not suitable.

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