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Defining and Achieving Optimum Therapeutic Goals in Critically Ill Patients
Author(s) -
Dasta Joseph E,
Brackett Carolyn C.
Publication year - 1994
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/j.1875-9114.1994.tb04160.x
Subject(s) - critically ill , oxygen transport , sepsis , oxygenation , intensive care medicine , medicine , hypoxia (environmental) , hemodynamics , shock (circulatory) , anaerobic exercise , septic shock , critical illness , endotoxic shock , oxygen metabolism , tissue hypoxia , oxygen , anesthesia , chemistry , physiology , organic chemistry
Patients who are critically ill with sepsis, shock, respiratory failure, trauma, or major surgical procedures may have reduced morbidity and mortality when hemodynamic and oxygen transport variables are augmented to values higher than those traditionally considered normal. Lactate production and suboptimum oxygen transport values are associated with anaerobic metabolism and insufficient tissue oxygenation. Since lactate can be a marker of inadequate tissue oxygenation, serial lactate measurements may be useful in individualizing therapy to reverse tissue hypoxia. Optimum hemodynamic and oxygen transport values are highly individual, and no accepted method has been established for guiding therapy. These values, together with plasma lactate concentrations, may assist in individualizing therapy in critically ill patients. No consensus can be reached at this time as to which specific therapeutic end points are optimal, how to achieve these end points, and which subset of patients will benefit from this therapy.