Resuscitation

Adequate fluid administration is essential to ensure adequate perfusion and to prevent worsening of tissue ischemia. The maintenance of hypovolemia (particularly when associated with vasopressor therapy to maintain arterial pressure) may increase the likelihood of multiple organ failure.

Adequate oxygen delivery to the tissues by the use of oxygen, transfusion of red blood cells to maintain a hemoglobin greater than 10 g/dl, and administration of pharmacological agents to maintain adequate cardiac output is essential in the prevention and treatment of multiple organ failure. A low mixed venous oxygen saturation (Svo2) should be avoided. Blood lactate levels may be a more valuable guide to the adequacy of oxygen delivery ( Do2). Gastric intramucosal pH values (pH.) may also give useful additional information.

Nutritional support should be commenced as soon as the cardiovascular status has been stabilized. Whenever possible, the enteral route is preferred to maintain gut integrity and function. If full enteral nutrition is not tolerated, parenteral nutrition or a combination of both should be administered. Nutrients may not be well utilized in the presence of acute circulatory failure (shock), and enteral nutrition may even be harmful if the gut oxygen requirements exceed the oxygen availability.

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