Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Early norepinephrine resuscitation of lifethreatening hypotensive septic shock: it can do the job, but at what cost? | Kipnis and Vallet Critical Care 2010 14 450 http content 14 6 450 CRITICAL CARE LETTER L_ Early norepinephrine resuscitation of lifethreatening hypotensive septic shock it can do the job but at what cost Eric Kipnis and Benoit Vallet See related research by Hamzaoui etal. http content 14 4 R142 Hamzaoui and colleagues 1 recently reported the effects of early norepinephrine for septic shock with lifethreatening hypotension. Their observations first answer yes to the question Can norepinephrine alone restore mean arterial pressure MAP in septic shock Second as an answer to How does norepinephrine alone restore MAP they confirm that norepinephrine restores MAP despite minimal fluid administration through recruiting unstressed volume while allowing increased contractility despite increasing afterload. The most critical question that remains unanswered however is Should norepinephrine alone be used to restore MAP in septic shock If the price of fluid resuscitation may be edema and organ failure what may be the price of norepinephrine resuscitation The fear is that the very same effects that allow norepinephrine to recruit unstressed volume through alpha adrenergic effects on venous and arterial vasculature might recruit volume to the macrovasculature all the while decreasing flow in previously critically collapsible microvascular beds. Answers to this crucial question are still unclear. In two previous conflicting studies showing beneficial 2 or detrimental 3 effects on microvascular blood flow the discrepancies may have been due to differences in prior fluid therapy and ensuing preload reserve. In order to determine the optimal use of norepinephrine future studies of microcirculation and perfusion should either optimize on an indicator of fluid responsiveness during the fluid therapy preceding norepinephrine treatment or rapidly wean the inevitable early norepinephrine infusion rate once the targeted MAP is obtained by screening for and .
