End points of resuscitation

End points of resuscitation

It is much easier to know when to start resuscitation than when to stop. Traditionally , patients have been resuscitated until they have a normal pulse, blood pressure and urine output. However, these parameters are monitoring organ systems whose blood flow is preserved until the late stages of shock. A patient therefore may be resuscitated to restore central perfusion to the brain, lungs and kidneys and yet continue to underperfuse the gut and muscle beds. Thus, activation of inflammation and coagulation may be ongoing and lead to reperfusion injury when these organs are finally perfused, and ultimately multiple organ failure. This state of normal vital signs and continued underperfu sion is termed ‘occult hypoperfusion’. With current monitoring techniques, it is manifested only by a persistent lactic acidosis and low mixed venous oxygen saturation. T he time spent by patients in this hypoperfused state has a dramatic e ff ect on outcome. Patients with occult hypoperfusion for more than 12 /uni00A0 hours have two to three times the mortality of patients with a limited duration of shock. Resuscitation algorithms directed at correcting global perfusion end points (base deficit, lactate, mixed venous oxygen saturation) rather than traditional end points have been shown to improve mortality and morbidity in high-risk surgical patients. However, it is also clear that aggressive crystalloid resus citation regimens can lead to tissue oedema and organ fail ure, especially acute respira tory distress syndrome, abdominal compartment syndrome and cerebral oedema. Some patients cannot be resuscitated to normal parameters within 12 hours Karl Landsteiner , 1868–1943, Professor of Pathological Anatomy , University of Vienna, Austria. In 1909 he classified the human blood groups into A, B, AB and O. For this he was awarded the Nobel Prize in Physiology or Medicine in 1930. Hans Gerhard Creutzfeldt , 1885–1946, neurologist, Kiel, Germany . Alfons Maria Jakob , 1884–1931, neurologist, Hamburg, Germany . patients to be judicious in the approach to all therapies as end points are approached. End points of resuscitation

It is much easier to know when to start resuscitation than when to stop. Traditionally , patients have been resuscitated until they have a normal pulse, blood pressure and urine output. However, these parameters are monitoring organ systems whose blood flow is preserved until the late stages of shock. A patient therefore may be resuscitated to restore central perfusion to the brain, lungs and kidneys and yet continue to underperfuse the gut and muscle beds. Thus, activation of inflammation and coagulation may be ongoing and lead to reperfusion injury when these organs are finally perfused, and ultimately multiple organ failure. This state of normal vital signs and continued underperfu sion is termed ‘occult hypoperfusion’. With current monitoring techniques, it is manifested only by a persistent lactic acidosis and low mixed venous oxygen saturation. T he time spent by patients in this hypoperfused state has a dramatic e ff ect on outcome. Patients with occult hypoperfusion for more than 12 /uni00A0 hours have two to three times the mortality of patients with a limited duration of shock. Resuscitation algorithms directed at correcting global perfusion end points (base deficit, lactate, mixed venous oxygen saturation) rather than traditional end points have been shown to improve mortality and morbidity in high-risk surgical patients. However, it is also clear that aggressive crystalloid resus citation regimens can lead to tissue oedema and organ fail ure, especially acute respira tory distress syndrome, abdominal compartment syndrome and cerebral oedema. Some patients cannot be resuscitated to normal parameters within 12 hours Karl Landsteiner , 1868–1943, Professor of Pathological Anatomy , University of Vienna, Austria. In 1909 he classified the human blood groups into A, B, AB and O. For this he was awarded the Nobel Prize in Physiology or Medicine in 1930. Hans Gerhard Creutzfeldt , 1885–1946, neurologist, Kiel, Germany . Alfons Maria Jakob , 1884–1931, neurologist, Hamburg, Germany . patients to be judicious in the approach to all therapies as end points are approached. End points of resuscitation

It is much easier to know when to start resuscitation than when to stop. Traditionally , patients have been resuscitated until they have a normal pulse, blood pressure and urine output. However, these parameters are monitoring organ systems whose blood flow is preserved until the late stages of shock. A patient therefore may be resuscitated to restore central perfusion to the brain, lungs and kidneys and yet continue to underperfuse the gut and muscle beds. Thus, activation of inflammation and coagulation may be ongoing and lead to reperfusion injury when these organs are finally perfused, and ultimately multiple organ failure. This state of normal vital signs and continued underperfu sion is termed ‘occult hypoperfusion’. With current monitoring techniques, it is manifested only by a persistent lactic acidosis and low mixed venous oxygen saturation. T he time spent by patients in this hypoperfused state has a dramatic e ff ect on outcome. Patients with occult hypoperfusion for more than 12 /uni00A0 hours have two to three times the mortality of patients with a limited duration of shock. Resuscitation algorithms directed at correcting global perfusion end points (base deficit, lactate, mixed venous oxygen saturation) rather than traditional end points have been shown to improve mortality and morbidity in high-risk surgical patients. However, it is also clear that aggressive crystalloid resus citation regimens can lead to tissue oedema and organ fail ure, especially acute respira tory distress syndrome, abdominal compartment syndrome and cerebral oedema. Some patients cannot be resuscitated to normal parameters within 12 hours Karl Landsteiner , 1868–1943, Professor of Pathological Anatomy , University of Vienna, Austria. In 1909 he classified the human blood groups into A, B, AB and O. For this he was awarded the Nobel Prize in Physiology or Medicine in 1930. Hans Gerhard Creutzfeldt , 1885–1946, neurologist, Kiel, Germany . Alfons Maria Jakob , 1884–1931, neurologist, Hamburg, Germany . patients to be judicious in the approach to all therapies as end points are approached.