The arrogant ass from Harvard argues against a physiologic approach in resuscitating shock while harboring bias for relying heavily on large artery pressure - never mind he holds a patent on a device that measures blood pressure.
An argument against the physiologic!
The reason this so deeply disturbs me centers on an alarmingly poor understanding of cardiovascular physiology and pathophysiology by most physicians - even many academics - and the arrogance of our 'leaders' who think the answer is not better education but instead to dumb it down for the 'not as gifted average doc'.
CVP, urine output, blood pressure, and LACTATE < 4 - the best we can do?
Without realizing it many docs have this bizarre idea that CVP drives output. That lactate is a branch point for ICU admission. That blood pressure and lactate reveal all one needs to know after drowning your patient in fluid.
Unfortunately we currently have no direct therapeutic interventions as regards maintaining capillary perfusion, maintenance of oxidative energy production, and overall cellular health - the ultimate aims of resuscitation. Yet. So perhaps then it makes no real difference if, for the time being, we use a physiologic approach vs. give them some fluid and norepinephrine, wave crystals and sprinkle goats blood on them as per our 'leaders' current guidelines.
But that does not mean our opinion leaders should get away with recommending the latter because ' it's easier and simpler' or serves their patents and purposes.
It is never a bad idea to understand true pathophysiology and to always approach the patient from the physiologic. Even if all we can do in response is blood let - that understanding and approach eventually leads to innovation and better ways of doing things.
An argument against the physiologic!
The reason this so deeply disturbs me centers on an alarmingly poor understanding of cardiovascular physiology and pathophysiology by most physicians - even many academics - and the arrogance of our 'leaders' who think the answer is not better education but instead to dumb it down for the 'not as gifted average doc'.
CVP, urine output, blood pressure, and LACTATE < 4 - the best we can do?
Without realizing it many docs have this bizarre idea that CVP drives output. That lactate is a branch point for ICU admission. That blood pressure and lactate reveal all one needs to know after drowning your patient in fluid.
Unfortunately we currently have no direct therapeutic interventions as regards maintaining capillary perfusion, maintenance of oxidative energy production, and overall cellular health - the ultimate aims of resuscitation. Yet. So perhaps then it makes no real difference if, for the time being, we use a physiologic approach vs. give them some fluid and norepinephrine, wave crystals and sprinkle goats blood on them as per our 'leaders' current guidelines.
But that does not mean our opinion leaders should get away with recommending the latter because ' it's easier and simpler' or serves their patents and purposes.
It is never a bad idea to understand true pathophysiology and to always approach the patient from the physiologic. Even if all we can do in response is blood let - that understanding and approach eventually leads to innovation and better ways of doing things.
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