Đang chuẩn bị nút TẢI XUỐNG, xin hãy chờ
Tải xuống
Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Early resuscitation in the emergency room: dramatic effects that we should not ignore. | Available online http ccforum.eom content 6 1 007 Commentary Early resuscitation in the emergency room dramatic effects that we should not ignore David Bennett Professor of Intensive Care St George s Hospital London UK Correspondence David Bennett cicfib@easynet.co.uk Published online 17 January 2002 Critical Care 2002 6 7-8 2002 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Keywords resuscitation septic shock treatment outcome A recently reported paper by Rivers et al. 1 describes a pivotal study that clearly demonstrates that early goal-directed therapy has a significant role to play in the management of the critically ill septic patient. This of course contradicts the results obtained both by Hayes et al. 2 and Gattinoni et al. 3 . Those groups demonstrated that targeting oxygen delivery to a level of 600 ml min per m2 or a mixed venous saturation greater than 70 did not improve outcome and indeed increased mortality in a subgroup of patients 4 who were unable to reach the target values. The most surprising finding in the study reported by Rivers et al. 1 was the baseline value of 48 for central venous saturations. This demonstrates that patients with severe sepsis septic shock when first admitted to the emergency room of a large US hospital must have extremely low cardiac outputs implying severe hypovolaemia although there is also likely to be significant myocardial depression. Those of us working in the intensive care unit ICU environment rarely encounter values as low as this in septic patients presumably because most patients will have already received at least some volume resuscitation before admission to the ICU. Rivers et al. chose central venous saturation and lactate as targets for their early goal-directed therapy protocol with the aim of achieving central venous saturation of greater than 70 and lactate of less than 2 mmol l while the patients remained in the emergency room. These were presumably chosen as relatively simply measured .
