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: Challenging the rationale of routine vasopressor therapy for management of hypotension. | Available online http content 13 4 179 Commentary Challenging the rationale of routine vasopressor therapy for management of hypotension Max Harry Weil and Wanchun Tang Weil Institute of Critical Care Medicine Rancho Mirage CA 92270 USA Corresponding author Max Harry Weil weilm@ Published 14 August 2009 This article is online at http content 13 4 179 2009 BioMed Central Ltd Critical Care 2009 13 179 doi cc7976 See related research by Dubin et al. http content 13 3 R92 Abstract There is persuasive evidence including the present report by Dubin and colleagues of a dissociation between increases in arterial pressure produced by vasopressor agents and improvement in microvascular perfusion and delivery of vital substrates. Especially in settings of septic shock the current routine administration of adrenergic vasopressor therapy therefore may fail to reverse the primary defect. The largely universal treatment of hypotension associated with cardiogenic distributive septic and obstructive shock states with adrenergic vasopressor agents in the past century is based on the goal of restoring blood pressure to more normal levels. However the evidence that such treatment improves outcomes is assumed and as yet is not backed by the security of proven value based on controlled clinical trials. The current focus of treatment of shock states including septic shock has been almost entirely on the macrocirculation including heart rate and rhythm arterial pressure cardiac filling pressures and cardiac output arterial and mixed venous oxygen saturation and calculated oxygen delivery and utilization. These hemodynamic variables are used to guide fluid repletion and vasopressor-inotropic interventions in an effort to optimize their values. With the recent availability of non-invasive techniques for visualization of the microcirculation in both clinical and experimental settings there is now persuasive evidence of a dissociation .
