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Critical Care Medicine

Answer 2
  1. Administer another 500 mL bolus of normal saline. Again, the choice of fluid administered is not as critical as timely administration of fluid, even in the presence of acute respiratory distress syndrome.1,2 Rivers et al3 emphasized the importance of early goal-directed therapy for treatment of sepsis before transfer to the intensive care unit. Their approach involved adjustment of cardiac preload, afterload, and contractility to balance oxygen delivery with oxygen demand. The reported in-hospital mortality rate was 30.5% in the early goal-directed therapy group compared with 46.5% in the standard therapy group. These goals have been incorporated into the Surviving Sepsis Campaign guidelines.

    1. Hollenberg SM, Ahrens TS, Annane D, et al. Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med 2004;32:1928-48.

    2. Evidence-based colloid use in the critically ill: American Thoracic Society Consensus Statement. American Thoracic Society. Am J Respir Crit Care Med 2004;170:1247-59.

    3. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. N Engl J Med 2001;345:1368-77.

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