If you wish to respond to a paper or other item already published in the BJA, please go to the abstract/full text version of that item and click on the link "E-Letters: Submit a response to the article".
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E-letters: Electronic letters published:
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Supranormal goals? Not really
- Mark C Bellamy (5 February 2007)
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Re: Judging by Slogging- Are we going back to Supranormal Goals?
- Pradeep Orakkan (14 January 2007)
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Judging by Slogging- Are we going back to Supranormal Goals?
- Pradeep Orakkan (27 November 2006)
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Mark C Bellamy
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I agree with your correspondents that going back to an era of supra- normalisation is unlikely to be helpful. But that is not what my editorial suggested: rather that fluid goals can, and should, be tailored to the individual patient. No single set of values applies to all. For some, best values may be below "supra-normal" and for others, greater than these pre- defined levels. The important point is that they can be readily defined for the individual, and when used as targets, produce better outcomes than non-targeted or random therapies. The era of rigid supra-normalisation is gone - for most patients! Conflict of Interest:None declared |
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Pradeep Orakkan, Spr-Anaesthetics The James Cook University Hospital, Marton Road, Middlesbrough, Cleveland, TS4 3BW;
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The idea of achieving supranormal goals to improve the treatment response in patients with shock has been always fascinating since the concept arose in 1970s. But later the enthusiasm slowly disappeared. During the process of achieving the supranormal goals there can be potential for fatal complications. For example if cardiac index is increased by using inotropes in a patient with ischaemic heart disease there is possibility increased strain on the heart resulting in a fatal myocardial infarction. To aim for supranormal goals may be of use in patients who have been otherwise without significant comorbidity.It is useful especially when they develop appropriate disease conditions like early sepsis which warrant aggressive resuscitation to prevent further deterioration. Conflict of Interest:None declared |
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Pradeep Orakkan, Spr-Anaesthetics
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The idea of achieving supranormal goals to improve the treatment response in patients with shock has been always fascinating since the concept aorse in 1970s. But later the enthusiasm slowly disappeared. During the process of achieving the supranormal goals there can be potential for fatal complications. For example if CI is increased by using inotropes in a patient with IHD there is possibility increased strain on the heart resulting in a fatal myocardial infarction. To aim for supranormal goals may be of use in patients who have been otherwise without significant comorbidity.Itis useful especially when they develope appropriate diseased conditions like early sepsis which warrants aggressive resuscitation to prevent further deterioration under close monitoring Conflict of Interest:None declared |
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