While the search continues for a panacea which will deliver the patient from sepsis, it must be remembered that responsivity is a reflection not only of pharmacologic manipulation, but of patient physiologic reserve. It is this which will determine the efficacy of interventions.Indeed,we have yet to determine if pharmacologic manipulation of physiologic parameters is either causative or merely associated with improved outcomes. Particularly since we lack the capacity to determine the microphysiologic cost of our therapy. Macrophysiologic goals become therapeutically cosmetic if iatrogenically induced unrecognized organ ischemia and it's related sequalae occur. The question then is perhaps not which vasopressor to select, but rather how to evaluate the underlying oxidative reserve of the septic patient and titrate therapy to an ever shifting anaerobic threshold during sepsis. This may then allow us to recognize those patients in need of metabolic modification rather than merely as "non responders".
Critical Care
In Seach of the Holy Grail
14 December 2005
While the search continues for a panacea which will deliver the patient from sepsis, it must be remembered that responsivity is a reflection not only of pharmacologic manipulation, but of patient physiologic reserve. It is this which will determine the efficacy of interventions.Indeed,we have yet to determine if pharmacologic manipulation of physiologic parameters is either causative or merely associated with improved outcomes. Particularly since we lack the capacity to determine the microphysiologic cost of our therapy. Macrophysiologic goals become therapeutically cosmetic if iatrogenically induced unrecognized organ ischemia and it's related sequalae occur. The question then is perhaps not which vasopressor to select, but rather how to evaluate the underlying oxidative reserve of the septic patient and titrate therapy to an ever shifting anaerobic threshold during sepsis. This may then allow us to recognize those patients in need of metabolic modification rather than merely as "non responders".
And so the search continues.
Competing interests
None declared