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: Advances in protocolising management of high risk surgical patients. | Available online http content 10 1 124 Commentary Advances in protocolising management of high risk surgical patients E David Bennett St George s Hospital Blackshaw Road London SW17 0QT UK Corresponding author E David Bennett ebennett4@ Published 20 February 2006 This article is online at http content 10 1 124 2006 BioMed Central Ltd Critical Care 2006 10 124 doi cc4848 Abstract Despite studies clearly demonstrating significant benefit from increasing oxygen delivery in the peri-operative period in high risk surgical patients the technique has not been widely accepted. This is due to a variety of reasons including non-availability of beds particularly in the pre-operative period and the requirement of inserting a pulmonary artery catheter. There are now data that suggest that increasing oxygen delivery post-operatively using a nurse-led protocol based on pulse contour analysis leads to a major improvement in outcome with reduction in infection rate and length of hospital stay. In 1988 Shoemaker and colleagues 1 published a pivotal and rather complex paper that demonstrated for the first time that increasing cardiac output and oxygen delivery peri-operatively in high risk surgical patients led to a dramatic fall in morbidity and mortality. His group had previously shown that using simple clinical criteria patients at high risk of dying in the post-operative period could be easily identified. He estimated that as many as 8 to 10 of patients undergoing major surgery in the USA were in this high risk group with a hospital mortality well in excess of 20 Since these papers were published numerous studies have by and large confirmed these original findings. Boyd and colleagues 2 and Woods and colleagues 3 found that increasing cardiac output and oxygen delivery pre-operatively to target values of l min m2 and 600 ml min m2 respectively which were maintained into the post-operative period all led to a dramatic reduction in both .
