Claire R. Sharp, BSc, BVMS(Hons), MS, MANZCVS, DACVECC
College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Murdoch, WA, Australia
Keynote Message
Early identification and treatment of shock is imperative to a successful outcome in affected patients. Treatment for shock aimed at improving oxygen delivery to the tissues should always be goal directed. Goal-directed resuscitation includes consideration of optimizing cardiac output by optimizing stroke volume, as well as arterial oxygen content. There is no single goal of successful resuscitation, rather a combination of parameters is monitored to guide when resuscitation has been adequate or to adjust resuscitation to meet the patients' needs. For the majority of resuscitation efforts in veterinary medicine, our goals are restoration of normal physical exam perfusion parameters and improvement in easily measured indicators, such as blood pressure and lactate. Recent evidence in human medicine suggests that these goals may be adequate as long as the patient is continually reassessed and treatment adjusted accordingly. This lecture will review the literature regarding early goal-directed therapy in human medicine and more recent literature of pragmatic randomized clinical trials of fluid resuscitation, including a discussion of how evidence in the human literature can be applied to veterinary medicine.
Key References
1. ARISE Investigators, ANZICS clinical trials group, Peake SL, et al. Goal-directed resuscitation for patients with early septic shock. N Eng J Med. 2014;371:1496–506. DOI: 10.1056/NEJMoa1404380.
2. Conti-Patara A, de Araújo Caldeira J, de Mattos-Junior E, et al. Changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization at admission to ICU and the relation to outcome. J Vet Emerg Crit Care. 2012;22:409–18. DOI: 10.1111/j.1476-4431.2012.00769.x.
3. Mouncey PR, Osborn TM, Power GS et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372:1301–11. DOI: 10.1056/NEJMoa1500896.
4. ProCESS Investigators, Yealy DM, Kellum JA, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014;370:1683–93. DOI: 10.1056/NEJMoa1401602.
5. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment if severe sepsis and septic shock. N Engl J Med. 2001;345:1368. DOI: 10.1056/NEJMoa010307.