tailieunhanh - Báo cáo y học: "Arterial pressure optimization in the treatment of septic shock: a complex puzzle"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Arterial pressure optimization in the treatment of septic shock: a complex puzzle. | Jones et al. Critical Care 2010 14 102 http content 14 1 102 CRITICAL CARE COMMENTARY L__ Arterial pressure optimization in the treatment of septic shock a complex puzzle Alan E Jones1 Stephen Trzeciak2 and R Phillip Dellinger 3 See related research by Dunser etal. http content 13 6 R181 Abstract Arterial pressure optimization in septic shock is a critical yet poorly understood component of resuscitation. New data suggest that during the routine management of patients with severe sepsis there is no association between mean arterial pressure achieved and outcome as long as the mean arterial pressure is maintained at or above 70 mmHg. Although these data add important new evidence to our understanding of arterial pressure management there are still many unanswered questions upon which future investigations should focus. In the previous issue of Critical Care Dunser and colleagues presented the results of post-hoc analysis that add another piece to the puzzle of understanding optimal arterial pressure goals in the treatment of sepsis 1 . The authors examine data from a control group of severe sepsis patients enrolled in an interventional trial that mandated hemodynamic management to specific therapeutic targets one of which was achievement of a mean arterial pressure MAP of 70 mmHg or higher through the use of vasopressors. Dunser and colleagues analyzed the association between the average MAP both as a continuous variable and grouped into quartiles and mortality. What they found was no association between average MAP or MAP quartiles above 70 mmHg and 28-day mortality. They did however report an association between vasopressor load and mortality. In his classic text Physiology of Shock published in 1950 Dr Carl J Wiggers wrote In short there are no pathognomonic signs of shock . The instability of a patient s Correspondence dellinger-phil@ 3Division of Critical Care Medicine Cooper University Hospital One Cooper Plaza

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