tailieunhanh - Báo cáo y học: " The optimal endpoint of resuscitation in trauma patients"

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: The optimal endpoint of resuscitation in trauma patients. | Available online http content 7 1 19 Commentary The optimal endpoint of resuscitation in trauma patients Paul E Marik Professor of Medicine and Critical Care Department of Critical Care Medicine University of Pittsburgh Pittsburgh Pennsylvania USA Correspondence Paul E Marik e-mail pmarik@ Published online 20 December 2002 Critical Care 2003 7 19-20 DOI cc1862 This article is online at http content 7 1 19 2003 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Abstract Although it has never been prospectively validated the base excess BE is regarded as the standard end-point of resuscitation in trauma patients. In a rat hemorrhage model in this edition of Critical Care Totapally and colleagues demonstrate that the BE is an insensitive and slowly responsive indicator of changes in intravascular volume. This contrasts with changes in the esophageal-arterial carbon dioxide gap which more closely followed changes in blood volume. Esophageal or sublingual capnometry may prove to be a useful tool for monitoring the adequacy of resuscitation in trauma victims. Keywords base excess carbon dioxide esophageal capnometry hemorrhage resuscitation sublingual capnometry tissue hypoxia trauma The assessment of intravascular volume and the adequacy of volume resuscitation are among the most difficult clinical challenges. Systolic blood pressure heart rate and urine output change minimally in early hemorrhagic shock. Hypotension tachycardia cold extremities decreased urine output and poor capillary refill are only present in patients who have lost in excess of 30 of their blood volume class III hemorrhage 1 . Furthermore both the central venous pressure and the changes in the central venous pressure in response to volume loading are poor indicators of intravascular volume and recruitable cardiac index 2 . While flow to the brain and the myocardium is preserved in patients with compensated shock splanchnic and renal perfusion may