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Fri Aug 17 23:44:57 BST 2007

Mathias, wie geht's ?

Listen..I don't think you're right. Do you wanna keep the SBP at 30 ?

What they are saying is that pts. with a SBP below 110 are going to be in trouble, meaning you need to do something for them at that level of BP and not at a lower level, like we do now when we follow the "Delayed fluid resuscitation" philosophy.
The new thing is the higher SBP at which the patients started having a pooreer outcome. Until now we thought that SBP of 90 based on the Delayed fluid resusci. paper from NEJM was OK, but they're opposing that in effect.

It is true that Near infrared spectroscopy or other measure of oxygen delivery or consumption (continuous SvO2, pH, repeat lactate) should be better, however they are not being utilized clinically for continuous measurement as of now, so we only have the BP. (not sure why we don't put oximetric Swans - anybody knows ? ).
Ivan Hronek MDChief, Critical Care & Trauma AnesthesiaSFMC Gas, Inc.St. Francis Medical Center3630 E. Imperial HighwayLynwood, CA 90262 Cell: 310 487-3288Pager: 310 636-6020

> Date: Fri, 17 Aug 2007 21:34:53 +0200> From: listen at doc-kalkum.de> To: trauma-list at trauma.org> Subject: Re: Hypotension Begins at 110 mm Hg: Redefining "Hypotension" With Data.> > Ivan,> > This to me is an important study. It goes against the delayed fluid resuscitation philosophy.> > The way to put them together would be to use vasopressors.> > You will satisfy the SBP requirement and you will still not be giving fluids.Ivan Hronek MDChief, Critical Care & Trauma AnesthesiaSFMC Gas, Inc.St. Francis Medical Center3630 E. Imperial HighwayLynwood, CA 90262 Cell: 310 487-3288Pager: 310 636-6020> > well, to me this study does add nothing new: we all knew very well> before that the severer one is hurt, the lower his blood pressure gets.> We all knew before that the lower the blood pressure gets, the more one> is prone to die. What Ken and others have shown before is that *we do> wrong if we still believe that we safe lives if we keep our focus on the> keeping blood pressure above level XYZ (replace with your favorite value)*.> > Blood pressure is one surrogate parameter for a patients condition,> perhaps not the best. It is not the evil in itself.> > Mathias> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/

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Poor Outcome Begins Already Below SBP 110..