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 International Sepsis Forum’s frontiers in sepsis: high cardiac output should be maintained in severe sepsis. | Critical Care August 2003 Vol 7 No 4 Vincent Commentary The International Sepsis Forum s frontiers in sepsis high cardiac output should be maintained in severe sepsis Jean-Louis Vincent Head Department of Intensive Care Erasme Hospital University of Brussels Brussels Belgium Correspondence Jean-Louis Vincent jlvincen@ Published online 4 July 2003 Critical Care 2003 7 276-278 DOI cc2349 This article is online at http content 7 4 276 2003 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Abstract Despite a usually normal or high cardiac output severe sepsis is associated with inadequate tissue oxygenation leading to organ failure and death. Some authors have suggested that raising cardiac output and oxygen delivery to predetermined supranormal values may be associated with improved survival. While this may be of benefit in certain patients bringing all patients to similar supranormal values is simplistic. It is much preferable to titrate therapy according to the needs of each individual patient. A combination of variables should be used for this purpose in addition to a careful clinical evaluation including not only cardiac output but also the mixed venous oxygen saturation and the blood lactate concentrations. The concept is to assess the adequacy of the cardiac output in patients with severe sepsis enabling management strategies aimed at optimizing cardiac output to be tailored to the individual patient. Keywords mixed venous oxygen oxygen delivery oxygen uptake saturation Introduction Sepsis is associated with systemic mediator-induced alterations in oxygen utilization including increased oxygen demand altered oxygen extraction and decreased myocardial contractility Fig. 1 . Hence despite a normal or high cardiac output severe sepsis and septic shock are characterized by an inadequate organ oxygenation leading ultimately to multiple organ failure and death. Almost 20 years ago Abraham and colleagues 1 noted that survivors .
