Endpoints in resuscitation

Christopher R. Connelly, Martin Schreiber

    Research output: Contribution to journalArticle

    8 Citations (Scopus)

    Abstract

    Purpose of review Shock occurs because of a failure to deliver adequate oxygen to meet the metabolic demands of the body resulting in metabolic acidosis, inflammation, and coagulopathy. Resuscitation is the process of treating shock in an attempt to restore normal physiology. Various hemodynamic, metabolic, and regional endpoints have been described to evaluate the degree of shock and guide resuscitation efforts. We will briefly describe these endpoints, and propose damage control resuscitation as an additional endpoint. Recent findings Serum lactate, base deficit, and pH are well established endpoints of resuscitation that provide valuable information when trended over time; however, a single value is inadequate to determine adequacy of resuscitation. Rapid normalization of central venous oxygen concentration has been associated with improved survival, and bedside transthoracic echocardiography can be a reliable assessment of volume status. In hypovolemic/hemorrhagic shock, early hypotensive, or controlled resuscitation strategies have been associated with improved survival, and hemostatic strategies guided by thrombelastography using a balanced transfusion approach result in improved hemostasis. Summary Numerous endpoints are available; however, no single endpoint is universally applicable. Damage control resuscitation strategies have demonstrated improved survival, hemostasis, and less early death from exsanguination, suggesting that hemorrhage control should be an additional endpoint in resuscitation.

    Original languageEnglish (US)
    Pages (from-to)512-519
    Number of pages8
    JournalCurrent Opinion in Critical Care
    Volume21
    Issue number6
    DOIs
    StatePublished - 2015

    Fingerprint

    Resuscitation
    Shock
    Hemostasis
    Exsanguination
    Oxygen
    Thrombelastography
    Hemorrhagic Shock
    Hemostatics
    Acidosis
    Echocardiography
    Lactic Acid
    Hemodynamics
    Hemorrhage
    Inflammation
    Serum

    Keywords

    • Damage control resuscitation
    • Endpoints in resuscitation
    • Hemostatic resuscitation

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine

    Cite this

    Endpoints in resuscitation. / Connelly, Christopher R.; Schreiber, Martin.

    In: Current Opinion in Critical Care, Vol. 21, No. 6, 2015, p. 512-519.

    Research output: Contribution to journalArticle

    Connelly, Christopher R. ; Schreiber, Martin. / Endpoints in resuscitation. In: Current Opinion in Critical Care. 2015 ; Vol. 21, No. 6. pp. 512-519.
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