tailieunhanh - Báo cáo y học: " Recently published papers: New evidence for old debates, new drugs and some timely reminders"

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 y học đề tài: Recently published papers: New evidence for old debates, new drugs and some timely reminders. | Available online http content 6 5 407 Commentary Recently published papers New evidence for old debates new drugs and some timely reminders Jonathan Ball1 and Gareth Williams2 1 Lecturer in Intensive Care Medicine St George s Hospital Medical School London UK 2Clinical Fellow in Intensive Care Medicine St George s Hospital Blackshaw Road Tooting London UK Correspondence Jonathan Ball Published online 5 September 2002 Critical Care 2002 6 407-410 This article is online at http content 6 5 407 2002 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X The present article provides a brief synopsis from the past 2 month s critical care literature. Sepsis There has been a longstanding debate in the fields of sepsis and multiple organ dysfunction syndrome regarding the relative importance of microcirculatory failure versus mitochondrial failure. This debate stems from the observation that in the presence of supranormal oxygen delivery there is frequently a failure to achieve normal levels of consumption and there is an association between the magnitude of this discrepancy and outcome. Accordingly measures of global oxygen consumption such as mixed or central venous oxygen saturations plasma lactate and base deficit are widely considered the best markers of the adequacy of resuscitation. Using a novel method of intravital microscopy of the sublingual mucosa de Backer and colleagues have demonstrated that mieroeireulatory perfusion is reduced by 50 despite normal global haemodynamic parameters and that shunting by larger vessels is commonplace 1 . This confirms previous animal and tissue studies and despite the excellent pictures see http egi eontent full 166 1 16 DC1 is unsurprising. Of note the authors found that the degree of severity correlated with the outcome. What is remarkable however is the demonstration using this intravital microscopy technique of the preservation of local vascular .