Use of survivors' cardiorespiratory values as therapeutic goals in septic shock.
The responses to therapy of 29 patients in septic shock are described. Patients received controlled plasma volume expansion followed by infusions of norepinephrine, dobutamine, and dopamine to achieve appropriate therapeutic goals. Increases in oxygen delivery (Do2) from 605 +/- 40 (SEM) to 843 +/- 27 ml/min-m2 (p less than .001) were associated with increases in oxygen consumption (Vo2) from 130 +/- 6.8 to 169 +/- 6.2 ml/min.m2 (p less than .001). The overall hospital survival rate was 52%. We suggest that the rational use of adrenergic agents and the achievement of appropriate physiologic end-points for therapy not only result in the reversal of hypotension, but also maintain or increase Do2 and Vo2, and may improve survival.
Edwards
J D
JD
Intensive Care Unit, University Hospital of South Manchester UK.
Brown
G C
GC
Nightingale
P
P
Slater
R M
RM
Faragher
E B
EB
D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods*; D004280:Dobutamine / Q000627:therapeutic use*; D004298:Dopamine / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D010101:Oxygen Consumption; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011446:Prospective Studies; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy*
D010952:Plasma Substitutes; D004280:Dobutamine; D004298:Dopamine; D009638:Norepinephrine