tailieunhanh - Báo cáo y học: "Septic shock resuscitation: what goals and how to achieve them"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Septic shock resuscitation: what goals and how to achieve them? | Available online http content 13 3 147 Commentary Septic shock resuscitation what goals and how to achieve them Stephan M Jakob Department of Intensive Care Medicine University Hospital Bern Inselspital and University of Bern CH-3010 Bern Switzerland Corresponding author Stephan Jakob Published 18 May 2009 This article is online at http content 13 3 147 2009 BioMed Central Ltd Critical Care 2009 13 147 doi cc7870 See related research by Palizas et al. http content 13 2 R44 Abstract The need to achieve adequate tissue oxygen delivery early in patients with septic shock is well established. However it is less well recognized that tissue hypoperfusion can exist despite normalization of systemic hemodynamics. Efforts to resuscitate septic patients until adequate tissue perfusion has been achieved can potentially improve outcome. In a multicenter study 130 patients with septic shock were resuscitated within 12 hours of diagnosis using a protocol including goals for mean arterial and pulmonary artery occluded pressures urinary output arterial pH and hemoglobin goals. They were then randomly assigned to further resuscitation with either a cardiac index 3 l minute per m2 or a gastric mucosal pH target. The intensive care unit length of stay and 28-day mortality did not differ between groups but more patients in the cardiac index group were in the target range both at baseline and after resuscitation as compared with the gastric mucosal pH group. In contrast to cardiac index gastric mucosal pH at baseline and at 24 and 48 hours predicted mortality. Whether other targets for the chosen variables or different and - in particular - earlier resuscitation efforts would have favored one group cannot be concluded from the data provided. The previous issue of Critical Care includes a report of a multicenter study in which cardiac index and gastric mucosal pH targets were compared during resuscitation of .