Steroids sepsis nejm

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Hi Scott This was a very enjoyable listen, thank you. I do though have some concerns regarding some of the comments regarding permissive hypotension. It was alluded to that the rationale for employing controlled/permissive hypotension was based on surgical need to decrease the amount of bleeding and that it lead to morbidity. We know that hypotension leads to worsening acidosis, impaired renal function and increasing lactate, but we also know (since Cotton/Bickell et al in late 90s) that being hosed with crystalloid and chasing normotension leads to increased mortality. I have rarely seen a subject cause more confusion and it must be remembered that controlled hypotension/damage control resuscitation should be reserved for a small subset of patients for who we believe it will confer benefit. They are predominantly the exsanguinating patient from a penetrating mechanism and it has to be in a centre that has robust systems to move them on rapidly for theatre. Of course, protracted hypotension is deleterious so this should be a temporary strategy usually only utilised pre-hospital in the ED. When I talk to anaethetists about this I use the analogy of a moribund AAA patient which most are very comfortable with and used to managing. …  Read more »

I have to disagree with these studies findings. If you look at the NEJM study, their rates of bystander CPR is 80% and there time to BLS is a mean of 1 minute. Where in America outside of Washington and Arizona do we see these numbers? Their survival to neurologically favorable discharge is also in the 40s – 50s %, again not numbers that are replicated by most communities in the USA.
Until we are producing outcomes and numbers as good as the ones in these studies, I don’t think that we should change hypothermia as of just yet.

PCCM: The 1st International Sepsis Forum on Sepsis in Infants and Children with Dr. Adrienne Randolph
Adrienne Randolph, MD, MSc, served as guest editor for the May 2005 supplement of Pediatric Critical Care Medicine. Dr. Randolph shares her thoughts on the importance of the 1st International Sepsis Forum on Sepsis in Infants and Children and the Pediatric Acute Lung Injury and Sepsis Investigator’s (PALISI) Network. She also highlights the most important aspects from the supplement, which she played such an instrumental role in producing. Ped Crit Care Med. 2005;6(3) (Suppl S1-S2)

Steroids sepsis nejm

steroids sepsis nejm

PCCM: The 1st International Sepsis Forum on Sepsis in Infants and Children with Dr. Adrienne Randolph
Adrienne Randolph, MD, MSc, served as guest editor for the May 2005 supplement of Pediatric Critical Care Medicine. Dr. Randolph shares her thoughts on the importance of the 1st International Sepsis Forum on Sepsis in Infants and Children and the Pediatric Acute Lung Injury and Sepsis Investigator’s (PALISI) Network. She also highlights the most important aspects from the supplement, which she played such an instrumental role in producing. Ped Crit Care Med. 2005;6(3) (Suppl S1-S2)

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