, , ( , , , , .
1. . - .
(prospective) , - , , - , , , , , , .
, (fluid challenge) ( ) () 500-1000 300-500 30 , ( ) ( ).
Vasopressors
(fluid challenge) , . , (life-threatening hypotension), , .
Dobutamine (first-choice inotrope) ( ) . , . , inotrope/vasopressor norepinephrine dopamine. () , , norepinephrine inotrope, dobutamine, , .
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, .
( 200-300 / , 7 3 4 ) , , , .
, , (randomized, controlled trial -RCT) ( - ACTH cortisol ≤ 9μg/dl) [39]. RCTS (significant effects on shock reversal) ]. ( [SBP] < 90 mmHg vasopressors), (SBP > 90 mmHg vasopressors).
250 μg ACTH , (> 9 μg /dl) cortisol 30-60 ACTH) . , . , > 9 μg /dl 250 μg ACTH ( ) , . , , cortisol (- ). . , , cortisol, cortisol , cortisol , . , dexamethasone , ACTH , dexamethasone, , cortisol. >300 , , . , .
I. C (Recombinant activated protein C - rhAPC)
1. RhAPC (APACHE II > 25, , ARDS) ( ) , () rhAPC (. B ). . . RhAPC, , , , , .
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J.
1. , , (. ), , < 7.0 g/dl (< 70 g/1) 7.0-9.0 g/dl (70-90 g/1). , (Transfusion Requirements in Critical Care - TRICC) 7-9 / (70-90 /), . 7.0 g/dl (70 g/1) . , , , [51, 52, 53]. 30 % O2 6 .
2. (Erythropoietin) , , , , , () .