tailieunhanh - Báo cáo y học: "Formulas The pursuit of a high central venous oxygen saturation in sepsis: growing concern"

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: Formulas The pursuit of a high central venous oxygen saturation in sepsis: growing concerns. | Available online http content 12 2 130 Commentary The pursuit of a high central venous oxygen saturation in sepsis growing concerns Rinaldo Bellomo Michael C Reade and Stephen J Warrillow Department of Intensive Care Austin Hospital Studley Rd Heidelberg Victoria 3084 Australia Corresponding author Rinaldo Bellomo Published 7 April 2008 This article is online at http content 12 2 130 2008 BioMed Central Ltd Critical Care 2008 12 130 doi cc6841 See related research by van Beest et al. http content 12 2 R33 Abstract In this issue of Critical Care Dutch investigators report that in a cohort of patients with sepsis septic shock admitted to three different intensive care units ICUs low central venous oxygen saturation ScvO2 was uncommon at the time of ICU admission and hospital mortality was 30 . Their findings taken together with those of recent reports from Australia and New Zealand ANZ raise serious concerns about the utility of early goal directed therapy EGDT outside the context of the original trial. Despite inclusion of EGDT into the Surviving Sepsis Guidelines in response to growing uncertainty ANZ and US investigators will soon begin randomization of patients into two large multicentre trials comparing EGDT to standard therapy. Until such studies are completed basing international treatment guidelines on a single centre study performed in what may turn out to be a highly atypical environment would seem premature. Many physicians believe that global hypoxia secondary to inadequate oxygen delivery DO2 is responsible for organ failure during severe sepsis. Others believe that sepsis is an inflammatory condition in which abnormalities of DO2 are uncommon. The relative importance of each of these hypotheses and indeed whether other unknown factors play a role is simply not known. The issue of DO2 and oxygen consumption in sepsis is highlighted in the paper by van Beest and colleagues 1 in this