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Even though our findings should be the same at earlier phases of shock, the decision to reduce cardiac preload is less often taken at the initial phase of haemodynamic resuscitation.
Future studies are needed to determine whether its expression during late phases of shock may be related to early interventions.
However, the idea to rapidly adapt fluid therapy to the respective pathophysiological phases of shock appears to be logical and may represent one of the crucial determinants in fighting septic shock (i.e., a timely and rational approach).
This concept, which has also been described by Hoste et al. in a slightly modified version, focuses on the clinical phases of shock from the initial "Salvage" or "Rescue" phase (where maintenance of a life-saving blood pressure with bolus infusion of fluids is recommended) until the "De-Escalation" phase (where a negative fluid balance should be achieved) [ 18, 19].
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All patients were included after the resuscitation phase of shock.
All patients were included after the initial phase of shock resuscitation.
Testing preload dependence may also be helpful in the de-escalation phase of shock management.
For instance, tubular necrosis explains that acute kidney injury persists in spite of resolution of the acute phase of shock (Fig. 1).
The present study aimed at exploring the impact of the Haldane effect on PcvaCO2 and PcvaCO2/CavO2 during the early phase of shock.
JAMA,2005,294 7):813–818. 3. Julie B, Thierry B, Stephan E, et al. Relation between mean arterial pressure and renal function in the early phase of shock: a prospective, explorative cohort study.
After the first hit which can be sepsis, but also burns, pancreatitis or trauma, the patient will enter the "ebb" phase of shock.
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