In a mice model of uncontrolled hemorrhagic shock, a MAP directed resuscitation associating norepinephrine and fluid resuscitation decreased blood loss and fluid requirements compared to a MAP directed resuscitation with fluid without norepinephrine while preserving intestinal microcirculatory perfusion and oxygenation.
1. Tánczos K, Németh M, Trásy D, et al. Goal-Directed Resuscitation Aiming Cardiac Index Masks Residual Hypovolemia: An Animal Experiment.
In the future, protocol directed resuscitation might be applicable to shock profiles other than sepsis.
In this model the physician, present on the ambulance, directs resuscitation, treatment and transport to the appropriate center for definitive care.
However, this measure has not been shown to be superior to less invasive techniques in directing resuscitation or in improving outcome.
Interestingly, in support of this hypothesis, goal directed resuscitation in critically ill patients with septic shock improves blood lactate concentrations over its six hours of therapy [ 26].
The protocol includes: i) clinical data needed for severe sepsis/septic shock identification; ii) instruction for 'sepsis team' activation; iii) detailed instructions for early goal directed resuscitation, collection of microbiological samples and antibiotic therapy; and iv) special recommendations on bicarbonate use, low-dose dopamine and glycaemia control.
We have previously shown that direct peritoneal resuscitation (DPR), as an adjunct to traditional IV fluid resuscitation, improves visceral blood flow and reduces pro-inflammatory cytokines released during HS.
A new treatment, direct peritoneal resuscitation (DPR), stabilizes vital organ blood flow after conventionally resuscitated shock to improve these derangements.
A new treatment, direct peritoneal resuscitation (DPR), might improve these derangements in acute brain death (ABD).
