What is a Clinician to Do?
What is a Clinician to Do?
复制标题
临床医生要做什么？
DOI：
10.1097/ccm.0000000000003174
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发表时间：
2018
影响因子：
8.8
通讯作者：
Deutschman,CliffordS
中科院分区：
文献类型：
--
作者：
Deutschman,CliffordS
社论1206 www. ccm杂志。 org 2018 年 7 月• 第 46 卷• 假设的第 7 号。拯救脓毒症运动的建议明确将 MAP 大于或等于 65 mm Hg 作为复苏目标，但并不表明较高的 MAP 具有优势 (16)。脓毒症引起的大脑异常在临床和实验文献中都有详细描述，但它们似乎并不是由CBF不足引起的。与脓毒症相关的两种最令人担忧的大脑异常是急性脑病和长期认知障碍。许多研究都暗示 CBF 与任一疾病之间存在关系 (9, 17)，但还远未确定。而且，对“标准护理可能会使脓毒症患者不必要地接受长期高剂量升压药治疗”的担忧仅反映了这些药物对 CBF 的影响。必须考虑血管加压药维持或维持其他器官系统功能的需要。总之，尽管 Masse 等人的工作 (1) 具有指导意义，但其临床实用性仍不清楚。在实施之前需要大量额外数据。
Editorials1206 www. ccmjournal. org July 2018• Volume 46• Number 7 for the hypothesis. The recommendations of the Surviving Sepsis Campaign clearly identify a MAP greater than or equal to 65 mm Hg as a resuscitation target but do not suggest that higher MAPs present an advantage (16). Sepsis-induced abnormalities in the brain are well described in both the clinical and experimental literature, but they do not appear to arise from inadequate CBF. The two most concerning sepsis-associated abnormalities of the brain are acute encephalopathy and long-term cognitive impairment. A number of studies have been hinted at a relationship between CBF and either disorder (9, 17), but they are far from definitive. And, the concern that “standard care may expose septic patients to prolonged high-dose vasopressor therapy unnecessarily” reflects only the effects of these agents on CBF. The need for vasopressors to preserve or maintain the function of other organ systems must be considered. In summary, although the work of Masse et al (1) is instructive, its clinical utility remains unclear. A significant amount of additional data will be required before it should be operationalized.