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🌱 來自: Huppert’s Notes
Shock Management🚧 施工中
Shock Management
• SMART Trial. New Engl J Med 2018;378(9):829–839.
- Multicenter, cluster-randomized, multiple crossover trial that randomized over 15,000 critically ill adult patients to receive saline (0.9% sodium chloride) or balanced crystalloids (Lactated Ringer’s solution or Plasma-Lyte A). Use of balanced crystalloids for fluid resuscitation in critically ill patients resulted in lower rate of the composite outcome of death from any cause, new renal replacement therapy, or persistent renal dysfunction than the use of saline.
• Rivers Trial. New Engl J Med 2001;345(19):1368–1377.
- Single-center, parallel-group, randomized controlled clinical trial that randomized 263 patients with severe sepsis or septic shock to either early goal-directed therapy or standard care. Early goal-directed therapy included several goals in the ER prior to ICU admission: CVP 8–12 mmHg achieved with fluid boluses, MAP >65 mmHg achieved with vasopressors if necessary, ScvO2 >70% achieved with PRBC transfusions and dobutamine if necessary, and urine output >0.5 mL/kg/hour. In this study, early goal-directed therapy for severe sepsis and septic shock showed mortality benefit vs. standard therapy. More recent studies have not shown this protocolized approach to be better than standard of care, likely because standard care involves many components of this process. However, targeting a CVP of 8–12 mmHg and transfusing pRBC for low ScvO2 is no longer routine care.