美国国家公共电台 NPR Did An IV Cocktail Of Vitamins And Drugs Save This Lumberjack From Sepsis?

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ARI SHAPIRO, HOST:

One year ago, a well-known intensive care physician announced that he just might have come across a cure for sepsis. This deadly reaction to infection kills around a quarter of a million people in the U.S. each year. It's the leading cause of death in hospitals. Scientists are now doing a new round of studies to see if that physician's treatment really does all he says it does. Meantime, some doctors have gone ahead and started using it on patients. NPR's Richard Harris reports.

RICHARD HARRIS, BYLINE¹: This story begins up in the Cascade² Mountains. Last summer, 51-year-old Kristopher Kelly was doing what he loved to do, cutting timber.

KRISTOPHER KELLY: I was cutting for a logging outfit³ up on these rock cliffs, and I fell about a 150-foot fir tree into these maple⁴ trees. They had a bunch of dead tops. We call them widow makers⁵.

HARRIS: And when the top of the fir tree crashed into those maples⁶, he says, the butt⁷ of the tree bounced back toward him.

KELLY: And I was against a rock cliff. I didn't have nowhere to go, and I got crushed.

HARRIS: He says the tree smashed his pelvis and broke all his ribs⁸, 22 bone breaks in all.

KELLY: I heard the bones crunch⁹ when it got me. It was pretty crazy. I'd yell for a minute, and then I'd pass out. And I guess my ribs were ripping my lungs is the reason I was only, you know, in and out of consciousness.

HARRIS: It took a couple of hours before other men working in the woods found him. Kelly says he's amazed he even lived that long. But they managed to get him off the mountain and send him by medevac helicopter to Harborview Medical Center in Seattle. And that, of course, was just the beginning of his medical journey.

KELLY: They had a bird cage, is what they call it. It's a metal apparatus¹⁰ that hold your pelvis together. And they put in - I've got a big piece of ready rod titanium keeping the hips¹¹ together, a couple, four or five little titanium plates and about a little over a dozen, they look like sheet metal screws, keeping the bones all together.

HARRIS: One of the big risks from injuries like this is infection that can start on wounds on the skin, from inside the lungs or from internal injuries. Those infections can quickly turn to septic shock, and that often leads to death. David Carlbom was one of many doctors who treated Kelly. And, sure enough...

DAVID CARLBOM: The day I met him, he developed a very high fever along with shock.

HARRIS: Carlbom recognized the signs of sepsis. He's among dozens of physicians nationwide who have been experimenting with a new treatment for sepsis. It involves intravenous vitamin C, thiamine, steroids and antibiotics¹². Carlbom thought Kelly would be a good candidate. Kelly was by then in a medically induced coma¹³.

CARLBOM: I discussed it with his son, and his son was very amenable¹⁴. We talked about the fact that it's a new therapy, that there really wasn't very strong evidence but I felt there was not a ton of risk and that this could be beneficial.

HARRIS: How quickly did he respond?

CARLBOM: Usually patients are very sick for a few days before responding to antibiotics, and, him, it took about a day. His fever had cleared, and he was off the medicines to support his blood pressure and looked remarkably¹⁵ better.

HARRIS: Carlbom has used this cocktail¹⁶ in 26 patients to date, sometimes getting really rapid responses, other times, to no avail. And he's well aware that these are simply anecdotes¹⁷, making it hard to know whether this combination is really effective.

CARLBOM: Could it just be that the antibiotics kill the bacteria really well - maybe. But I also think it's possible that this impacted his care and changed his course.

HARRIS: Other doctors at Harborview are not so enthusiastic. Dr. Terri Hough, the clinical director at the hospital's intensive care unit, remembers the breathless first reports about this treatment.

TERRI HOUGH: It seemed like, great, look, someone thinks that they have a new miracle cure again.

HARRIS: There's a long history in this field of medicine where something appears to work great in one hospital but simply doesn't pan out in larger-scale studies. Hough read the original paper from Dr. Paul Marik in Norfolk, Va., and remained skeptical¹⁸.

HOUGH: To me, this isn't enough evidence to change my practice.

HARRIS: Someone making an extraordinary claim needs to have extraordinary evidence to back that up.

HOUGH: And I would certainly argue that what we've seen so far is not the highest level of evidence.

HARRIS: That said, she is eager to hear about the results from a number of carefully designed studies that are underway or soon to start. And in the meantime, Kristopher Kelly is still getting surgeries to mend his injuries and to, as he puts it, reconnect his plumbing¹⁹.

KELLY: In our industry, when you get - usually when something like this happens, you don't get a chance to be flown out or anything. It's just, you know, that's the end of that. But I'm lucky. Richard Harris, NPR News.