Critical Care ATLAS

CHEST critical care Pub Date : 2023-12-23 DOI:10.1016/j.chstcc.2023.100043

Kelsey D. Sack MD, PhD , Chandrashish Chakravarty MD , Juliana Carvalho Ferreira MD, PhD , Daniela Helena Machado Freitas MD , Chris McGrath MBBCh , Mark E. Mikkelsen MD , Matteo Di Nardo MD , Elisabeth Riviello MD, MPH , Michael Root MD , Jon A. Silversides MBBCh (Hons), PhD , Theogene Twagirumugabe MD, PhD , Doris Uwamahoro MD

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Abstract

The practice of critical care depends not only on the particular patient population served, but also on the context in which critical care is provided, including culture and regional norms and resources. How clinicians interpret and implement new evidence or guideline recommendations is affected by their unique context. In 2023, the Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension (CLOVERS) trial was published. The CLOVERS trial included 1,563 patients and studied early vasopressor initiation vs liberal fluid initiation after an initial fluid bolus for patients with septic shock seeking treatment in the United States. No mortality difference was found between the two treatment arms. In this article, adult and pediatric critical care clinicians from the United States, the United Kingdom, Italy, Rwanda, India, and Brazil describe how CLOVERS has impacted or will impact their practice.

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重症监护 A.T.L.A.S CLOVERS

重症监护的实践不仅取决于所服务的特定患者群体，还取决于提供重症监护的环境，包括文化、地区规范和资源。临床医生如何解释和实施新证据或指南建议受到其独特环境的影响。2023 年，脓毒症诱发低血压的早期限制性或自由输液管理（CLOVERS）试验发表。CLOVERS 试验纳入了 1563 名患者，研究了在美国寻求治疗的脓毒性休克患者在初始液体栓注后早期使用血管加压剂与自由输液的对比。结果发现，两种治疗方法的死亡率没有差异。在这篇文章中，来自美国、英国、意大利、卢旺达、印度和巴西的成人和儿科重症监护临床医生介绍了 CLOVERS 对他们的临床实践产生了或将产生怎样的影响。

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CHEST critical care Critical Care and Intensive Care Medicine, Pulmonary and Respiratory Medicine

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