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<font size=3>Dr. Honreck, et al<br><br>
Two things:<br><br>
(1) As mentioned, a target BP in hypertensive patients for many
aggressive practitioners, and supported by footnote for high risk
individuals in the European Society for Hypertension/European Society of
Cardiology hypertension guidelines is 115/75 or "as low a BP as
tolerated". Thus, the use of SBP<110 as a screening
tool would cause the system to be activated for me at 105/65 this AM
(just before I took my AM BP meds) as I sit at my computer.<br><br>
(2) For the 2 years I did pure critical care, we essentially ALWAYS
placed SvO2 swans, and I firmly believe that much of the "swans
worsen or at least don't change outcomes except in the sickest
patients" data would not exist if SvO2 swans had been utilized (in
centers where both nurses and practitioners were well experienced and
trained on utilization of data, present 24/7). I admit these were
mostly in medical patients or post-op who got into trouble. Trauma
went across the street. However, your point is well taken - we
could respond to a drop in SvO2 that would occur HOURS before any other
indication of decompensation occurred. I suspect cost is the
influencing factor - I have forgotten the numbers, but they were very
expensive. The only other downside is that you can't place a Chandler
Wire for pacing via an SvO2 swan, but that isn't an issue in trauma.
<br><br>
Lorick<br><br>
At 01:44 AM 8/18/2007, you wrote:<br>
<blockquote type=cite class=cite cite="">Mathias, wie geht's ?<br>
<br>
Listen..I don't think you're right. Do you wanna keep the SBP at 30
?<br>
<br>
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.<br>
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.<br>
<br>
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 ? ).<br>
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<br><br>
<br><br>
> Date: Fri, 17 Aug 2007 21:34:53 +0200> From:
listen@doc-kalkum.de> To: trauma-list@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> -->
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