tailieunhanh - Báo cáo y học: "he outcome of patients presenting to the emergency department with severe sepsis or septic shock"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care cung cấp cho các bạn kiến thức về ngành y đề tài: The outcome of patients presenting to the emergency department with severe sepsis or septic shock. | Available online http content 10 4 154 Commentary The outcome of patients presenting to the emergency department with severe sepsis or septic shock Emanuel Rivers Emergency Medicine and Critical Care Henry Ford Hospital Detroit Michigan USA Corresponding author Emanuel Rivers ERIVERS1@ Published 31 July 2006 This article is online at http content 10 4 154 2006 BioMed Central Ltd Critical Care 2006 10 154 doi cc4973 See related research by Ho et al. http content 10 3 R80 Abstract Although multiple studies of acute myocardial infarction trauma and stroke have been translated into improved outcomes by applying diagnosis and therapy at the most proximal stage of hospital presentation before intensive care unit arrival this approach to the sepsis patient has been lacking. In response to this a trial comparing early goal-directed therapy EGDT versus standard care was performed using internally and externally validated criteria for early identification of high risk patients established definitions and a consensus-derived protocol to reverse the hemodynamic perturbations of hypovolemia vasoregulation myocardial suppression and increased metabolic demands. That trial of EGDT resulted in significant reductions in morbidity mortality vasopressor use and health care resource consumption. The end-points used in the protocol and the outcome results were subsequently externally validated revealing similar or better mortality benefit. This commentary examines the rational and validation for the use of early markers of illness severity. Current evidence support the endpoints in the EGDT protocol external validity in regards to outcome benefit and the universal need to improve the quality of care for early sepsis. A recent retrospective observational study by Ho and coworkers 1 measured the incidence and outcome of septic patients presenting at an Australian emergency department ED with criteria for early goal-directed therapy EGDT