Some interesting
questions were asked. For example, is lactate an indicator of tissue
oxygenation in sepsis? Evidence suggests it may be due to a
metabolic effect instead, unrelated to tissue hypoxia, that is, type
b lactic acidosis. Nevertheless it appears to be a useful marker to
follow. Certainly its elevation portends a worse outcome but maybe
not by the mechanism we think. See here. All this is not to
say that type a lactic acidosis does not exist (that is, is not due
to tissue ischemia in other forms of shock, in low cardiac output
states or in high demand states).
How strong is the
evidence in favor of fluid resuscitation in sepsis? Pretty weak.
The author talks around the idea, but comes short, of saying we
should stop doing it. He also talks around the idea, but comes just
short, of saying there is equipoise for a controlled trial of fluid
resuscitation versus no fluid resuscitation.
No comments:
Post a Comment