tailieunhanh - Báo cáo y học: "The high-risk surgical patient revisited"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: The high-risk surgical patient revisited. | Bennett Critical Care 1998 2 1 http c CRITICAL CARE COMMENTARY The high-risk surgical patient revisited David Bennett 2cc-2-1-001 Full text The results of the various sepsis intervention studies and doubts about the efficacy of the pulmonary artery PA catheter have cast a considerable shadow over the intensive care community. They serve to highlight the importance of the recent paper published by Sinclair et al 1 in which the authors convincingly demonstrated that elderly patients undergoing surgery for a fractured neck of femur had a slightly significantly better outcome if they were aggressively volume loaded with colloid intraoperatively. They showed that the administration of an average of 750 ml of colloid during the course of the operation resulted in a highly significant reduction in hospital stay and a lower complication rate. The well-matched control group patients were treated conventionally only receiving crystalloid. The range of volumes of colloid given to the protocol group of patients was considerable and the cardiovascular effects of the infusion were monitored using an intra-oesophageal Doppler device which measures descending aortic blood velocity and converts it into cardiac output using a built-in nomogram. Sinclair et al showed that following colloid infusion the protocol group of patients had significantly increased cardiac output and stroke volume when compared to their own baseline values and the control patients. This simple manoeuvre led to a 39 reduction in hospital stay and complication rate. The obvious question is could they have achieved the same result simply by administering the volume of colloid without monitoring cardiac output albeit with a relatively noninvasive device that is placed in the oesophagus. This is an important question because it is likely to determine whether such an approach to the management of similar high-risk patients will be generally accepted and become the standard. Others including Shoemaker et

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