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  This section relates to glucose control and bicarbonate therapy. For many years, physicians were not very aggressive about the treatment of hyperglycemia within the ICU, and it was not unusual to see patients with serum glucose levels above 200 mg/dL. In a 2001 landmark paper in the New England Journal of Medicine, van den Berghe and colleagues showed that intensive insulin therapy could improve survival in ICU patients. This changed the way intensivists approached...
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  This section relates to guideline recommendations pertinent to mechanical ventilation in the patient with acute respiratory distress syndrome.  The 2008 Surviving Sepsis Campaign guidelines recommended targeting a tidal volume of 6 mL/kg predicted body weight in patients with sepsis-induced acute lung injury. This recommendation has been continued in the 2012 guidelines, and is supported by the ARMA trial, which is described in the following slide. Because the ARM...
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Adjunctive therapy consists of several approaches to inhibit pathomechanisms of severe sepsis. The 2008 “positive“ formulation (“…only in patients…“) was reversed into a “negative“ phrasing according to the principle of “primum non nocere.“ As long as septic shock patients can be stabilized by volume and vasopressors, steroids should not be used. If this is not possible, thus raising the overall mortality risk, low-dose hydrocortisone could be used. According to some stu...
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Adjunctive therapy consists of several approaches to inhibit pathomechanisms of severe sepsis. This is a new recommendation since 2008 because a number of clinical studies have verified that formal screening protocols for sepsis improve outcome (Jones et al. JAMA. 2010;303:739-746; Moore et al. J Trauma. 2009;66:1539-1546). The underlined sections are new to the 2012 guidelines as ample evidence now exists to recommend these, rather than simple suggestions. (Memel L, Ma...
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This section relates to initial resuscitation. For many years, physicians recognized the importance of resuscitating patients with sepsis by administering fluids and vasopressors.In a 2001 landmark paper in the New England Journal of Medicine (Rivers E. N Engl J Med. 2001;345:1368-1377), Rivers and colleagues showed that a protocolized quantitative resuscitation protocol could improve survival in ICU patients with septic shock. This changed the way intensivists approached...
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The Surviving Sepsis Campaign (SSC) has published recommendations and guidelines for the management of severe sepsis and septic shock. Each of the authors who wrote a section of the publication has prepared a slide presentation for that section with emphasis on the changes from the 2008 to the 2012 recommendations and the reasons for them. The European Society of Intensive Care Medicine (ESICM) and Society of Critical Care Medicine (SCCM) are making these slide presentati...
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近日,拯救全身性感染行动(Surviving Sepsis Campaign, SSC)在其官方网站(www.survivingsepsis.org)发布了有关SSC 2012年指南的幻灯片,以帮助读者深入理解指南内容。 幻灯片共包括12个部分 Grading of Recommendations: G. Rubenfeld Initial Resuscitation: D. Annane Infection-Related Issues: S. Opal Adjunctive Therapy: H. Gerlach Mechanical Ventilation: J. Sevransky Glucose Control, Bicarbonate Therapy: C. Sprung Nutrition: F. Machado, D. Angus Renal Replacement Therapy: S. Townsend Pro...
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Low intraoperative tidal volume ventilation with minimal PEEP is associated with increased mortality. ICM Index Number: 21/035 Authors: Levin MA, McCormick PJ, Lin HM, Hosseinian L, Fischer GW. Reference: Br J Anaesth 2014; doi:10.1093/bja/aeu054. © The Board of Management and Trustees of the British Journal of Anaesthesia. ICM ABSTRACT Objective To determine whether the use of low intraoperative tidal volumes (VT) in surgical patients is associated with a decrease in mor...
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开腹手术全麻期间高PEEP与低PEEP (PROVHILO实验):一项多中心,随机,对照试验 The PROVE Network Investigators†for the Clinical Trial Network of the European Society of Anaesthesiology (本研究已在线发表在Lancet杂志网站) 摘要 背景 手术全麻期间机械通气时PEEP的作用尚不清楚。超过0 cmH2O的PEEP能够预防术后肺部并发症,但也可能导致术中循环功能抑制,或因过度膨胀引起肺损伤。我们对如下假设进行验证,对于并发症的高危患者,在开腹手术全麻期间应用小潮气量机械通气过程中,高PEEP及肺复张能够...
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  针对《呼吸内科的观点》的留言: 张...:作为一名呼吸内科出身的ICU医生,我认为呼吸内科转行的确有优势,但需要学习的只是依然无穷无尽,呼吸系统只是ICU众多复杂病变系统的一部分   针对《黄伟医生的观点》的留言: 张...:呼吸科的核心价值是什么?我都不知道   针对《杜斌医生的观点》的留言: 程...:趋势应该是专科ICU,没人要的去综合,这样各方利益也好协调,也符合目前决策中心分散的原则 ...:一个源于ICU的医生可能想问题更能考虑全身,而一个其他专科的再来搞ICU可能偏重器官,只是...
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