Effect of maximizing oxygen delivery on morbidity and mortality rates in critically ill patients

Yu, Mihae; Levy, Mitchell M.; Smith, Philip E. M.; Takiguchi, Sharon A.; Miyasaki, Alison; Myers, Sally

doi:10.1097/00003246-199306000-00009

Cited by 334 publications

(108 citation statements)

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“…This value is questionable given that the baseline mortality rates of the included studies were somewhat variable, as demonstrated in Table 1. [13][14][15][16][17] The implications of this study are in keeping with the Canadian Association of Emergency Physicians Sepsis Guidelines 18 recommendation for a quantitative resuscitation strategy. The implications are also consistent with the Surviving Sepsis Campaign 2008 Guidelines, 5 which specifically recommend early goal-directed therapy upon recognition of severe sepsis or septic shock, with the option to substitute mixed venous oxygen saturation in place of central venous oxygen saturation as the end point.…”

Section: ;12(2) 151mentioning

confidence: 76%

Quantitative resuscitation in sepsis

Patocka¹,

Turner

Lang

2010

CJEM

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Section: ;12(2) 151mentioning

confidence: 76%

Quantitative resuscitation in sepsis

Patocka¹,

Turner

Lang

2010

CJEM

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“…[11][12][13] Stres Gastritis biasanya memberi respons baik terhadap pembilasan lambung dan koreksi hemodinamik. 16 • Resusitasi cairan.…”

Section: Urutan Tata Laksana Kegawatan Dbdunclassified

“…Hal yang membatasi resusitasi cairan ialah apabila peningkatan preload atau pengisian ventrikel tidak diikuti oleh peningkatan curah jantung, tidak memperbaiki perfusi perifer dan vascular bed , atau malah meningkatkan tekanan vena, kebocoran vaskular, dan edema. [5][6][7][8][9][10][11][12][13][14][15] Bila volume yang diberikan lebih dari 50-100 ml/ kgbb dalam 1-2 jam pertama perlu dilakukan pemantauan invasif tekanan vena sentral (CVP) atau tekanan atrium kanan untuk menilai fungsi miokard. Bila CVP <10 mmHg berarti fungsi miokard masih baik dan resusitasi cairan dapat diteruskan.…”

Section: -15unclassified

Kegawatan Demam Berdarah Dengue pada Anak

Darwis¹

2016

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Kegawatan demam berdarah dengue (DBD) yang mengancam nyawa adalah disfungsi sirkulasi atau syok hipovolemik yang disebabkan oleh peningkatan permeabilitas kapilar dan perdarahan, sehingga terjadi plasma leakage, penurunan perfusi organ, penurunan suplai oksigen dan nutrien untuk sel yang dapat berlanjut dengan gagal organ multiple dan kematian. Tata laksana kegawatan DBD berorientasi pada pendekatan patofisiologik multi system terpadu yang diarahkan pada pemenuhan kebutuhan oksigen dan nutrien, termasuk didalamnya tunjangan ventilasi, pemberian oksigen, resusitasi cairan dan obat resusitasi. Resusitasi cairan paling baik diberikan saat syok kompensasi, dengan pemberian cairan kristaloid atau koloid secara agresif 10-30 ml/kgbb dalam 6-10 menit untuk meningkatkan preload, curah jantung, volume sirkulasi efektif, memperbaiki perfusi organ, sehingga mekanisme homeostatis atau mekanisme kompensasi tidak digunakan lagi dan kesembuhan segera pasien sindrom syok dengue dapat diharapkan.Kata kunci: disfungsi sirkulasi, syok hipovolemik, preload. Sari Pediatri, Vol. 4, No. 4, Maret 2003: 156 -162 A pelepasan oksigen di organ vital secara optimal.5,10 Pada keadaan suplai oksigen rendah, mekanisme neurohumoral terutama sistem saraf simpatis diaktifkan sehingga terjadi vasokonstriksi dan pengalihan aliran darah dari kulit, ginjal, saluran cerna dan otot rangka ke otak dan jantung. Perangsangan sistem saraf simpatis juga menyebabkan pelepasan norepinefrin dan epinefrin, katekolamin yang memberi efek serupa dengan stimulasi sistem saraf simpatis. 5Penurunan perfusi ginjal menyebabkan pelepasan renin, angiotensin II, aldosteron dan arginine vasopressin (AVP) sehingga terjadi retensi air dan sodium serta peningkatan volume intravaskular. Penurunan pH susunan saraf pusat merangsang kemoreseptor di daerah medula sehingga terjadi peningkatan volume tidal, frekuensi pernapasan, hiperventilasi, volume pernapasan semenit, dan alkalosis respiratorik. Secara umum pada anak sakit gawat, peningkatan aktivitas neurohumoral membantu pelepasan oksigen melalui hiperventilasi, vasokonstriksi, redistribusi aliran darah, peningkatan volume intravaskular, tekanan darah, denyut jantung dan kontraktilitas miokard. 5,10Penanganan awal seorang anak sakit gawat dilakukan melalui pendekatan pada disfungsi multisistem. Diarahkan pada optimalisasi mekanisme nak sakit gawat ialah anak nyawanya terancam oleh kekurangan suplai oksigen dan nutrien yang disebabkan oleh disfungsi respirasi dan kardiovaskular atau peningkatan kebutuhan oksigen pada berbagai keadaan stres seperti trauma, tindakan bedah, luka bakar, sepsis, demam tinggi, keracunan, syok, malformasi kongenital, keganasan, henti jantung-paru dan sakit gawat lain.

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“…Nine studies were included in the final analysis providing a total sample of 1001 subjects (4,(25)(26)(27)(28)(29)(30)(31)(32). Two full length articles in Chinese were translated to English, prior to analysis (32,33).…”

Section: Inclusionmentioning

confidence: 99%

207: The Effect of a Quantitative Resuscitation Strategy on Mortality in Patients With Sepsis: A Meta-Analysis

Jones

Brown

Trzeciak

et al. 2008

Annals of Emergency Medicine

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Objective-Quantitative resuscitation consists of structured cardiovascular intervention targeting predefined hemodynamic end points. We sought to measure the treatment effect of quantitative resuscitation on mortality from sepsis.Data Sources-We conducted a systematic review of the Cochrane Library, MEDLINE, EMBASE, CINAHL, conference proceedings, clinical practice guidelines, and other sources using a comprehensive strategy.Study Selection-We identified randomized control trials comparing quantitative resuscitation with standard resuscitation in adult patients who were diagnosed with sepsis using standard criteria. The primary outcome variable was mortality.Data Abstraction-Three authors independently extracted data and assessed study quality using standardized instruments; consensus was reached by conference. Preplanned subgroup analysis required studies to be categorized based on early (at the time of diagnosis) vs. late resuscitation implementation. We used the chi-square test and I 2 to assess for statistical heterogeneity (p < 0.10, I 2 > 25%). The primary analysis was based on the random effects model to produce pooled odds ratios with 95% confidence intervals.Results-The search yielded 29 potential publications; nine studies were included in the final analysis, providing a sample of 1001 patients. The combined results demonstrate a decrease in mortality (odds ratio 0.64, 95% confidence interval 0.43-0.96); however, there was statistically significant heterogeneity (p = 0.07, I 2 = 45%). Among the early quantitative resuscitation studies (n = 6) there was minimal heterogeneity (p = 0.40, I 2 = 2.4%) and a significant decrease in mortality (odds ratio 0.50, 95% confidence interval 0.37-0.69). The late quantitative resuscitation studies (n = 3) demonstrated no significant effect on mortality (odds ratio 1.16, 95% confidence interval 0.60-2.22). Despite its endorsement by 11 professional societies, the recommendation has produced significant controversy, in part because it relied heavily on one study (6-10). Conclusion-ThisScientific knowledge is cumulative; therefore new research findings should be interpreted based on what is already known (11). Recognizing that clinical trials of quantitative resuscitation were published for nearly two decades before the Rivers et al. study, we hypothesized that their results could be aggregated to produce more definitive conclusions about the treatment effect of quantitative resuscitation in sepsis. Therefore, we conducted a meta-analysis to examine the available evidence investigating a quantitative resuscitation strategy for patients with sepsis, to determine the treatment effect of such a strategy on mortality, and to determine whether the timing of implementation of quantitative resuscitation impacts mortality. METHODS Search Strategy for Identification of StudiesA written protocol following recommended guidelines that was finalized before beginning the study was followed (12). We searched the Cochrane Library, MEDLINE (1965( -August 2007, EMBASE (1974( -Augu...

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Effect of maximizing oxygen delivery on morbidity and mortality rates in critically ill patients

Cited by 334 publications

References 0 publications

Quantitative resuscitation in sepsis

Quantitative resuscitation in sepsis

Kegawatan Demam Berdarah Dengue pada Anak

207: The Effect of a Quantitative Resuscitation Strategy on Mortality in Patients With Sepsis: A Meta-Analysis

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