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: Bench-to-bedside review: The initial hemodynamic resuscitation of the septic patient according to Surviving Sepsis Campaign guidelines – does one size fit all? | Available online http content 12 5 223 Review Bench-to-bedside review The initial hemodynamic resuscitation of the septic patient according to Surviving Sepsis Campaign guidelines - does one size fit all Azriel Perel Department of Anesthesiology and Intensive Care Sheba Medical Center Tel Aviv University Tel Hashomer 52621 Israel Corresponding author Azriel Perel perelao@ Published 3 September 2008 Critical Care 2008 12 223 doi cc6979 This article is online at http content 12 5 223 2008 BioMed Central Ltd Abstract The Surviving Sepsis Campaign guidelines for the management of severe sepsis and septic shock recommend that the initial hemodynamic resuscitation be done according to the protocol used by Rivers and colleagues in their well-known early goal-directed therapy EGDT study. However it may well be that their patients were much sicker on admission than many other septic patients. Compared with other populations of septic patients the patients of Rivers and colleagues had a higher incidence of severe comorbidities a more severe hemodynamic status on admission excessively low central venous oxygen saturation ScvO2 low central venous pressure CVP and high lactate and higher mortality rates. Therefore it may well be that these patients arrived to the hospital in late untreated hypovolemic sepsis which may have been due in part at least to low socioeconomic status and reduced access to health care. The EGDT protocol uses target values for CVP and ScvO2 to guide hemodynamic management. However filling pressures do not reliably predict the response to fluid administration while the ScvO2 of septic patients is characteristically high due to decreased oxygen extraction. For all these reasons it seems that the hemodynamic component of the Surviving Sepsis Campaign guidelines cannot be applied to all septic patients particularly those who develop sepsis during their hospital stay. Background The early institution of goal-directed .
