title: Beyond the Golden Hours: Caring for Septic Patients After the Initial Resuscitation.
abstract: Recognition and management of agitation, delirium, and pain are key areas. Reduced use of sedatives is an important measure that must be coupled with increased patient engagement, mobilization, and exercise. Use of low tidal volumes and low mean airway pressures during mechanical ventilation is helpful. A key hemodynamic principle following early aggressive volume resuscitation is subsequent careful assessment to avoid unnecessary additional volume administration and adverse consequences of frank volume overload. Substantial evidence now supports a lower hemoglobin transfusion threshold of 7 g/dL. A rush to initiate enteral or parenteral feeds is not clearly supported by the current evidence.
authors.affiliation: Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.
authors.forename: Jean P
authors.initials: JP
authors.lastname: Gelinas
authors.affiliation: Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada. Electronic address: Keith.Walley@hli.ubc.ca.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Walley
mesh_terms: D006439:Hemodynamics; D006801:Humans; D012121:Respiration, Artificial / Q000379:methods*; D012151:Resuscitation / Q000379:methods*; D018805:Sepsis / Q000150:complications / Q000628:therapy*
keywords: Delirium; Immune function; Mechanical ventilation; Resuscitation; Sepsis