儘管是針對早期目標導向治療在感染性休克中應用,作者提到氫可能在早期治療中具有重要價值,作者大膽提出設想,值得從事感染性休克的同行關注氫氣的生物學效應.
Recently published papers: More about EGDT, experimental
therapies and some inconvenient truths
Abstract
This issue’s recently published papers concentrates on early goal
directed therapy, starting with new data from the original study
through to new studies that may have a major bearing on the
treatment of septic shock in years to come. A timely reminder
about talking, walking and teaching clinical medicine completes the
roundup.
Early goals
No one is likely to argue with the belief that prompt and
appropriate treatment is effective and should be the standard
of care. Back in 2001, Emmanuel Rivers and colleagues
published their landmark study of Early Goal Directed
Therapy (EGDT) [1]. Perhaps the central concept behind
EGDT is that of oxygen debt and the secondary inflammatory
insult inflicted by tissue hypoxia, which is modifiable with
timely and aggressive cardiovascular support. A series of
recently published papers emphasise and further elucidate
this idea .
Firstly, Rivers and colleagues have published the results of a
study of serum biomarkers of systemic inflammation from the
majority of patients from their original study [2]. Patients had
multiple biomarkers measured periodically over the first 72
hours of their illness. Two separate comparative analyses
were performed. First, the protocol group are considered
against the standard care group. Second, the whole patient
population has been stratified into three groups by severity of
admission global dysoxia (serum lactate and central venous
oxygen saturations) and compared. Unfortunately, no third
analysis of these three groups separated into those in the
protocol and standard care groups was performed. Although
this post hoc separation would have yielded statistically small
groups, the results may well have provided useful hypothesis
generation rather than statistically significant results. The
results of the treatment comparison analysis demonstrate a
statistically significant reduction in the level of all markers in
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