Protocolized care for early shock resuscitation
| Autor: | Kaori Ito, Emanuel P. Rivers, Arielle H Gupta, Matthew Goodwin |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Resuscitation
medicine.medical_specialty 030204 cardiovascular system & hematology Early goal-directed therapy Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine Sepsis medicine Humans Myocardial infarction Intensive care medicine Septic shock business.industry 030208 emergency & critical care medicine Perioperative medicine.disease Quality Improvement Shock Septic Cardiac surgery Early Diagnosis Treatment Outcome Heart failure Shock (circulatory) medicine.symptom business |
| Zdroj: | Current opinion in critical care. 22(5) |
| ISSN: | 1531-7072 |
| Popis: | PURPOSE OF REVIEW Protocolized care for early shock resuscitation (PCESR) has been intensely examined over the last decade. The purpose is to review the pathophysiologic basis, historical origin, clinical applications, components and outcome implications of PCESR. RECENT FINDINGS PCESR is a multifaceted systems-based approach that includes early detection of high-risk patients and interventions to rapidly reverse hemodynamic perturbations that result in global or regional tissue hypoxia. It has been applied to perioperative surgery, trauma, cardiology (heart failure and acute myocardial infarction), pulmonary embolus, cardiac arrest, undifferentiated shock, postoperative cardiac surgery and pediatric septic shock. When this approach is used for adult septic shock, in particular, it is associated with a mortality reduction from 46.5 to less than 30% over the last 2 decades. Challenges to these findings are seen when repeated trials contain enrollment, diagnostic and therapeutic methodological differences. SUMMARY PCESR is more than a hemodynamic optimization procedure. It also provides an educational framework for the less experienced and objective recognition of clinical improvement or deterioration. It further minimizes practices' variation and provides objective measures that can be audited, evaluated and amendable to continuous quality improvement. As a result, morbidity and mortality are improved. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|