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General Critical Care

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Gangadhar Yalavatti

Thank you very much for the hemodynamic lecture series. I have few points

1: In pursuit of achieving the mean arterial pressure we forget to monitor the efficacy of the majors taken and the single most parameter which tells us that we are reasonably successful in our therapy if we start having reasonably good urine out out. This can be established either with fluid challenge alone or fluid challenge along with diuretics and sustaining this urine output is most vital.

2: In my practice i have seen when a patient is maintaining the MAP but inadequate oxygenation the moment he is intubated and paralysed his MAP drops to below 60 because of the abolished sympathetic drive. But these patients still maintain good urine out put and gradually recover their MAP with nor epinephrine and and dobutamine.

3: In critical care practice it is very difficult to pinpoint the exact dosage regime of inotropes to maintain the internal homeostasis and need to be titrated depending on patients need at the bed side and which may vary minute by minute and we can't standardize a regime for 24 hours and leave it alone.

Mazen Kherallah
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