2,833 publications from this institution
High PEEP strategy may have a clinically relevant independent mortality benefit. Despite a possible increase in baro-trauma, the benefits far outweigh potential risks. Current evidence therefore favors the use of high PEEP as the preferred option when ventilating patients with severe acute respiratory distress syndrome. As the reduction in absolute risk of death is less than 5%, a future clinical trial aimed at demonstrating statistical significance is likely to pose considerable financial and ethical burdens.
More than a decade ago, observations of co-variance between VO2 and DO2 led to the identification of a condition known as pathological O2 supply dependency. This condition was subsequently observed in critically ill patients with sepsis and acute circulatory failure. More recently, other authors have challenged the existence of this condition, often citing methodologic problems or mathematical coupling to account for spurious observations in the earlier studies. Here, we review the evidence for and against pathological O2 supply dependency. We find that many of the arguments have some validity but only in specific circumstances. We conclude, therefore, that pathological O2 supply dependency is a hallmark of acute circulatory failure and that an effective therapeutic approach should be based on an evaluation of organ system function in each individual case. Parameters such as blood lactate, pHi and veno-arterial PCO2 may be useful in this respect.
Sepsis has been recognized for more than 2500 years, but the criteria used to identify it have evolved. Sepsis is an infection associated with some degree of organ dysfunction-put very simplistically, sepsis is a 'bad infection'. Specific criteria may be useful for research purposes but have less value in day-to-day clinical practice. What is relevant here is early recognition and some awareness of severity so that appropriate therapy can be started without delay.
The last two decades have witnessed a remarkable expansion in the understanding of sepsis, its origins, consequences and outcomes: the pace of advancement in this field has been so great that articles and books are frequently out of date by the time they reach publication. As the various aspects of the septic cascade have been elucidated, we have begun to understand just how complex and involved this response is; as such, it is virtually impossible in any one article to describe each individual detail of each intricate pathway. Here we aim to draw together all the essential elements of the inflammatory response to sepsis, but the reader is encouraged to engage with the primary research papers. We concentrate on some of the most recent developments in this field and the ways in which these may impact on our clinical practice.
info:eu-repo/semantics/published
