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Showing posts from December, 2017

"Time to Reanimate Il-1ra for Sepsis" by Steven P. LaRosa, M.D.

My introduction to the world of clinical trials in sepsis occurred in the 1990’s while I was an Internal Medicine Resident in the MICU at the Cleveland Clinic. My attending physician and ICU director, Charles J. Fisher, Jr, was the lead investigator for the Phase III trial of Interleukin-1 receptor antagonist (IL-1 ra) in patients with sepsis. The basis of the strategy related to the discovery by Charles Dinarello, M.D. of IL-1 and the role it played in the pathophysiology of febrile vasodilatory shock. During this rotation I had the opportunity to enroll a patient of mine into this trial. He was a previously healthy 28 year old male who perforated his bowel as an initial presentation of inflammatory bowel disease. At the time of enrollment the patient was maxed out on vasopressors for septic shock, in ARDS, DIC and acute renal failure. Within 24 hours of beginning the study drug infusion the patient had a miraculous improvement and ultimately survived. When the study blind was broken