Recently published papers More about EGDT, experimental therapies and some inconvenient truths 英文参考文献.docVIP

Available online /content/11/5/171 Commentary Recently published papers: More about EGDT, experimental therapies and some inconvenient truths Jonathan Ball General Intensive Care Unit, St George’s Hospital, London SW17 0QT, UK Corresponding author: Jonathan Ball, jball@sgul.ac.uk Published: 26 October 2007 Critical Care 2007, 11:171 (doi:10.1186/cc6145) This article is online at /content/11/5/171 ? 2007 BioMed Central Ltd Abstract the protocol group. However, the time course and magnitude of this difference is markedly different between the This issue’s recently published papers concentrates on early goal directed therapy, starting with new data from the original study through to new studies that may have a major bearing on the treatment of septic shock in years to come. A timely reminder about talking, walking and teaching clinical medicine completes the roundup. substrates. EGDT appears to obtund the early peak in interleukin 1 receptor antagonist and tumour necrosis factor alpha (although the baseline level was significantly higher in the protocol group). Perhaps the most striking difference however was in caspase-3, a marker of cellular apoptosis, the level of which fell dramatically in the protocol group and remained at a much lower level throughout the 72 hours, suggesting that EGDT reduced the secondary insult of oxygen debt. In the second analysis, unsurprisingly, the most dysoxic group at baseline had the highest and most persistently elevated levels of all the markers. Also note- worthy is the late (after 24 hours) but dramatic rise in caspase-3 in the middle group. Overall, this study provides additional and valuable biological plausibility to the oxygen debt hypothesis. I hope the third analysis suggested above is forthcoming. Early goals No one is likely to argue