Totem and Taboo Fluids in sepsis 英文参考文献.docVIP

Hilton and Bellomo Critical Care 2011,15:164 /content/15/3/164 COMMENTARY Totem and Taboo: Fluids in sepsis Andrew K Hilton and Rinaldo Bellomo* 1 2 pressure or end-organ perfusion (an elusive outcome given that organ blood ? ow cannot be accurately measured in septic humans). Finally, experi mental data show that organ perfusion is supranormal in hyperdynamic sepsis [12] and that ? uid resuscitation may increase mortality [13]. Abstract The need for early, rapid, and substantial ?uid resuscitation in septic patients has long been an article of faith in the intensive care community, a tribal totem that is taboo to question. The results of a recent multicenter trial in septic children in Africa, published in The New England Journal of Medicine, powerfully challenge the ?uid paradigm. The salient aspects of the trial need to be understood and re?ected upon. In this commentary, we discuss the background to and ?ndings of the trial and explain why they will likely trigger a re-evaluation of our thinking about ?uids in sepsis, a re-evaluation that is already happening in the treatment of acute respiratory distress syndrome and acute kidney injury and in postoperative care. e publication of FEAST (Fluid Expansion As Suppor erapy in critically ill African children) [14] challenges the widely held totemic beliefs in the protective power of ? uids in severe sepsis. It also breaks the taboo that has made any challenge to ? uid therapy in the sepsis paradigm an act of unspeakable tribal treason. Yet FEAST is the ? rst large and randomized study of the relationship between volume and composition of intravenous ? uids and clinical outcome in acute severe sepsis. e results challenge the status quo. FEASTenrolled Sub-Saharan African children with a severe febrile illness (prostration, coma,