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A trial of goal-oriented hemodynamic therapy in critically ill patientsGattinoni, Luciano ...Background. Hemodynamic therapy to raise the cardiac index and oxygen deliveryto supranormal may improve outcomes in critically ill patients. We studied whether increasing the cardiac index to a ... supranormal level (cardiac-index group) or increasing mixed venous oxygen saturation to a normallevel (oxygen-saturation group) would decrease morbidity and mortality among critically ill patients, as compared with a control group in which the target was a normal cardiac index. Methods. A total of 10,726 patients in 56 intensive care units were screened, among whom 762 patients belonging to predefined diagnostic categories with acute physiology scores of 11 or higher were randomly assigned to the three groups (252 to the control group, 253 to the cardiac-index group, and 257 to the oxygen-saturation group). Results. Thehemodynamic targets were reached by 94.3 percent of the control group, 44.9percent of the cardiac-index group, and 66.7 percent of the oxygen-saturation group (P < 0.001). Mortality was 48.4, 48.6, and 52.1 percent, respectively (P = 0.638), up to the time of discharge from the intensive care unit and 62.3, 61.7, and 63.8 percent (P = 0.875) at six months. Among patients who survived, the number of dysfunctional organs and the length of the stay in the intensive care unit were similar in the three groups. No differences in mortality among the three groups were found for any diagnostic category. A subgroup analysis of the patients in whom hemodynamic targets were reached revealed similar mortality rates: 44.8, 40.4, and 39.0 percent, respectively (P = 0.478). Conclusion. Hemodynamic therapy aimed at achieving supranormal values for the cardiac index or normal values for mixed venous oxygen saturation does not reduce morbidity or mortality among critically ill patients.Vir: The New England journal of medicine. - ISSN 0028-4793 (Letn. 333, št. 16, 1995, str. 1025-1032)Vrsta gradiva - članek, sestavni delLeto - 1995Jezik - angleškiCOBISS.SI-ID - 21994201
Avtor
Gattinoni, Luciano |
Špec-Marn, Ana |
Kremžar, Boriana, 1943- |
Paver-Eržen, Vesna
Teme
Cardiac Output |
Adult |
Critical Illness |
Mortality |
Therapy |
Erythrocyte Transfusion |
Oxygen |
Blood |
Oxygen Consumption |
Survival Analysis |
Treatment Outcome |
Vasoconstrictor Agents |
Therapeutic Use |
Vasodilator Agents |
Therapeutic Use |
Srčni, minutni volumen |
Eritrocitna transfuzija |
Kisik |
Kisik, poraba |
Kritična bolezen |
Odrasli |
Preživetje, analiza |
Vazodilatatorji |
Vazokonstriktorji |
Zdravljenje, izid
Vnos na polico
Trajna povezava
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JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
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Povezave do osebnih bibliografij avtorjev | Povezave do podatkov o raziskovalcih v sistemu SICRIS |
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Gattinoni, Luciano | |
Špec-Marn, Ana | 12252 |
Kremžar, Boriana, 1943- | 12257 |
Paver-Eržen, Vesna | 02259 |
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