Septic shock resuscitation what goals and how to achieve them 英文参考文献.docVIP

Available online /content/13/3/147 Commentary Septic shock resuscitation: what goals and how to achieve them? Stephan M Jakob Department of Intensive Care Medicine, University Hospital Bern (Inselspital) and University of Bern, CH-3010 Bern, Switzerland Corresponding author: Stephan Jakob, Stephan.Jakob@insel.ch Published: 18 May 2009 Critical Care 2009, 13:147 (doi:10.1186/cc7870) This article is online at /content/13/3/147 ? 2009 BioMed Central Ltd See related research by Palizas et al., /content/13/2/R44 Abstract shock [2]. Gastric mucosal pH (pHi) is an interesting parameter that has been shown to predict outcome in many patient groups [3,4]. However, pHi-guided resuscitation has not improved survival rates. pHi is a composite variable that reflects not just adequacy of local perfusion but also systemic metabolic acid-base homeostasis and ventilation. The inter- action of the components of pHi and their response to treat- The need to achieve adequate tissue oxygen delivery early in patients with septic shock is well established. However, it is less well recognized that tissue hypoperfusion can exist despite normalization of systemic hemodynamics. Efforts to resuscitate septic patients until adequate tissue perfusion has been achieved can potentially improve outcome. In a multicenter study, 130 patients with septic shock were resuscitated within 12 hours of diagnosis using a protocol including goals for mean arterial and pulmonary artery occluded pressures, urinary output, arterial pH, and hemoglobin goals. They were then randomly assigned to ment may confound the interpretation and prognostic relevance of gastric mucosal acidosis. further resuscitation with either a cardiac index (≥3 l/minute per m2) or a gastric mucosal pH (≥7.32) target. The intensive care unit In the study conducted by Palizas and coworkers [1], resu