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Flashcards in Journal Club Deck (6)
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1
Q

What were the physiologic goals/parameters in the Rivers 2001 Early goal directed study? (4)

A
  1. CVP 8-12mmHg, achieved with fluid boluses
    (CVP was measured CONTINUOUSLY for first 6 hours and assessed q 12)
  2. MAP >65mmHg, achieved with vasopressors if necessary
  3. ScvO2 >70%, achieved with packed RBC transfusions and dobutamine if necessary
  4. UOP >0.5mL/kg/hr
2
Q

What was the primary result in the Rivers et. al 2001 EGDT trial?

A

With the use of EGDT bundle there was a significant reduction of mortality 46.5% in standard group vs. 30.5 60 day mortality in EGDT. Thats a 16% mortality reduction.
NNT = 6

3
Q

What did the ProCESS trial show? 2014

A

That there was no mortality difference between the EGDT vs. protocol vs ‘usual’ (non protocolized) care. Mortality was approximately 20%

4
Q

What did the Kumar et. al 2010 Critical care study show?

A

Combination antibiotic therapy improves survival and clinical response of high-risk, life-threatening infections, particularly those associated with septic shock. But it may be detrimental in low risk patients.

5
Q

From the ProCESS trial what is the take home point?

A

This is whats important:

  1. Early recognition of severe sepsis, and septic shock
  2. Early Administration of Fluids
  3. Early Administration of Antibiotics
6
Q

What did the TRICC (transfusion requirements in critical care) trial show?

A

Multi-centre RCT. ICU. NEJM 1999

Among critically ill patients, a restrictive transfusion strategy (hemoglobin goal of 7-9 g/dL) was associated with improved survival compared with a liberal transfusion strategy (Hgb goal of 10-12 g/dL).