Equipment review The success of early goal-directed therapy for septic shock prompts evaluation of current approaches for monitoring the adequacy of resuscitation.docVIP

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Equipment review The success of early goal-directed therapy for septic shock prompts evaluation of current approaches for monitoring the adequacy of resuscitation.doc

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Equipment review The success of early goal-directed therapy for septic shock prompts evaluation of current approaches for monitoring the adequacy of resuscitation

Available online /content/9/4/349 Review Equipment review: The success of early goal-directed therapy for septic shock prompts evaluation of current approaches for monitoring the adequacy of resuscitation Scott R Gunn1, Mitchell P Fink2 and Benjamin Wallace3 1Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA 2Departments of Critical Care Medicine and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA 3European Marketing Manager Critical Care, Edwards Lifesciences Corresponding author: Mitchell P Fink, finkmp@ Published online: 27 May 2005 Critical Care 2005, 9:349-359 (DOI 10.1186/cc3725) This article is online at /content/9/4/349 ? 2005 BioMed Central Ltd See editorial, page 307 [/content/9/4/307] Abstract inflammatory response syndrome (SIRS) and a systolic blood pressure below 90 mmHg (after a 30 ml/kg fluid challenge) or a blood lactate concentration of 4 mmol/l or greater resulted in a hospital mortality rate of 30.5%, which was significantly less than the mortality rate (46.5%) in the cohort randomly assigned to usual care. As a result of this single-center randomized trial, the use of ScvO2 was given a grade B recommendation in the recent Surviving Sepsis Campaign recommendations [2]. A recent trial utilizing central venous oxygen saturation (SCVO ) as 2 a resuscitation marker in patients with sepsis has resulted in its inclusion in the Surviving Sepsis Campaign guidelines. We review the evidence behind SCVO2 and its relationship to previous trials of goal-directed therapy. We compare SCVO to other tools for 2 assessing the adequacy of resuscitation including physical examination, biochemical markers, pulmonary artery catheterization, esophageal Doppler, pulse contour analysis, echocardiography, pulse pressure variation, and tissue capnometry. It is unlikely that any single technology can impr