title: End Points of Sepsis Resuscitation.
abstract: Resuscitation goals for the patient with sepsis and septic shock are to return the patient to a physiologic state that promotes adequate end-organ perfusion along with matching metabolic supply and demand. Ideal resuscitation end points should assess the adequacy of tissue oxygen delivery and oxygen consumption, and be quantifiable and reproducible. Despite years of research, a single resuscitation end point to assess adequacy of resuscitation has yet to be found. Thus, the clinician must rely on multiple end points to assess the patient's overall response to therapy. This review will discuss the role and limitations of central venous pressure (CVP), mean arterial pressure (MAP), and cardiac output/index as macrocirculatory resuscitation targets along with lactate, central venous oxygen saturation (ScvO2), central venous-arterial CO2gradient, urine output, and capillary refill time as microcirculatory resuscitation endpoints in patients with sepsis.
authors.affiliation: Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Ground Ravdin, Philadelphia, PA 19014, USA; Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Ground Ravdin, Philadelphia, PA 19014, USA. Electronic address: john.greenwood@uphs.upenn.edu.
authors.forename: John C
authors.initials: JC
authors.lastname: Greenwood
authors.affiliation: Department of Emergency Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Ground Ravdin, Philadelphia, PA 19104, USA.
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Orloski
mesh_terms: D001794:Blood Pressure; D002302:Cardiac Output; D004636:Emergency Service, Hospital; D023381:Endpoint Determination; D006801:Humans; D007773:Lactates / Q000097:blood; D008833:Microcirculation; D010100:Oxygen / Q000097:blood; D012151:Resuscitation; D018805:Sepsis / Q000628:therapy*; D012772:Shock, Septic / Q000628:therapy
chemical_list: D007773:Lactates; D010100:Oxygen
keywords: Capillary refill time; Critical care; Lactate; Resuscitation; Resuscitation end points; Sepsis; Septic shock