Antonelli Massimo, Levy Mitchell, Andrews Peter J D, Chastre Jean, Hudson Leonard D, Manthous Constantine, Meduri G Umberto, Moreno Rui P, Putensen Christian, Stewart Thomas, Torres Antoni
Istituto di Anestesiologia e Rianimazione, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy.
Intensive Care Med. 2007 Apr;33(4):575-90. doi: 10.1007/s00134-007-0531-4.
Shock is a severe syndrome resulting in multiple organ dysfunction and a high mortality rate. The goal of this consensus statement is to provide recommendations regarding the monitoring and management of the critically ill patient with shock.
An international consensus conference was held in April 2006 to develop recommendations for hemodynamic monitoring and implications for management of patients with shock. Evidence-based recommendations were developed, after conferring with experts and reviewing the pertinent literature, by a jury of 11 persons representing five critical care societies.
A total of 17 recommendations were developed to provide guidance to intensive care physicians monitoring and caring for the patient with shock. Topics addressed were as follows: (1) What are the epidemiologic and pathophysiologic features of shock in the ICU? (2) Should we monitor preload and fluid responsiveness in shock? (3) How and when should we monitor stroke volume or cardiac output in shock? (4) What markers of the regional and micro-circulation can be monitored, and how can cellular function be assessed in shock? (5) What is the evidence for using hemodynamic monitoring to direct therapy in shock? One of the most important recommendations was that hypotension is not required to define shock, and as a result, importance is assigned to the presence of inadequate tissue perfusion on physical examination. Given the current evidence, the only bio-marker recommended for diagnosis or staging of shock is blood lactate. The jury also recommended against the routine use of (1) the pulmonary artery catheter in shock and (2) static preload measurements used alone to predict fluid responsiveness.
This consensus statement provides 17 different recommendations pertaining to the monitoring and caring of patients with shock. There were some important questions that could not be fully addressed using an evidence-based approach, and areas needing further research were identified.
休克是一种导致多器官功能障碍且死亡率高的严重综合征。本共识声明的目的是提供关于休克危重症患者监测与管理的建议。
2006年4月召开了一次国际共识会议，以制定血流动力学监测的建议及对休克患者管理的启示。在与专家商议并查阅相关文献后，由代表五个重症监护学会的11人评审团制定了基于证据的建议。
共制定了17条建议，为重症监护医生监测和护理休克患者提供指导。涉及的主题如下：（1）重症监护病房中休克的流行病学和病理生理学特征是什么？（2）我们是否应该在休克中监测前负荷和液体反应性？（3）在休克中应如何以及何时监测每搏量或心输出量？（4）可以监测哪些区域和微循环标志物，以及如何在休克中评估细胞功能？（5）使用血流动力学监测指导休克治疗的证据是什么？最重要的建议之一是，休克的定义不需要低血压，因此，体格检查中组织灌注不足的存在被赋予重要性。鉴于目前的证据，推荐用于休克诊断或分期的唯一生物标志物是血乳酸。评审团还建议不常规使用（1）休克中的肺动脉导管和（2）单独使用的静态前负荷测量来预测液体反应性。
本共识声明提供了17条关于休克患者监测和护理的不同建议。存在一些重要问题无法使用基于证据的方法完全解决，并确定了需要进一步研究的领域。
