tailieunhanh - Báo cáo khoa học: "The key advance in the treatment of sepsis in the last 10 years … doing less"

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: The key advance in the treatment of sepsis in the last 10 years doing less. | Available online http content 10 1 122 Commentary The key advance in the treatment of sepsis in the last 10 years . doing less Mervyn Singer University College London Gower St London WC1E 6BT UK Corresponding author Mervyn Singer Published 16 February 2006 This article is online at http content 10 1 122 2006 BioMed Central Ltd Critical Care 2006 10 122 doi cc4849 Abstract Although many pharmaceutical and technological advances are heavily touted they have had relatively little impact on overall outcome improvements in the critically ill. Acting on the increasing recognition that less may be best has in my opinion been the greatest single advance in patient management in the intensive care unit in the past 10 years. Although certainly not qualifying as a brave new world in terms of daring and exciting innovation the importance of often covert iatrogenic complications should not be underestimated. About 20 of patients admitted to intensive care fail to leave the intensive care unit ICU alive and a further 8 to 10 die in hospital. Alas no new product - pharmaceutical or technological - has had an obvious major impact on overall ICU outcomes. Activated protein C for example is currently used in about 2 to 4 of patients admitted to UK ICUs. Assuming the 19 relative reduction in mortality reported in the PROWESS study 1 this translates to an outcome improvement in less than 1 of all patients admitted to the ICU. Yet more than a quarter of patients admitted to UK ICUs have sepsis diagnosed within 24 hours of admission 2 and probably as many again develop sepsis during their stay. I prescribe corticosteroids in septic shock with concurrent adrenal deficiency 3 and use terlipressin in catecholamineunresponsive septic shock 4 but any benefit gained also applies to a minority of my septic patients. I can provide anecdotal examples where I am convinced that the above interventions have provided benefit to individual patients .