Pino-Sánchez Francisca, Lara-Rosales Ramón, Guerrero-López Francisco, Chamorro-Marín Virginia, Navarrete-Navarro Pedro, Carazo-de la Fuente Eugenio, Fernández-Mondéjar Enrique
Intensive Care Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain.
J Trauma. 2009 Dec;67(6):1220-4. doi: 10.1097/TA.0b013e3181a5f1f1.
Preload parameters in postresuscitation phase are not sufficiently sensitive to guide fluid therapy in critically ill patients. We analyzed modifications in the fluid therapy and vasoactive drugs of critically ill patients that were produced by inclusion of extravascular lung water (EVLW) data in the treatment protocol and evaluated the short-term response.
This observational and prospective study included consecutive patients with hypotension or hypoxemia, comparing the therapeutic plan for fluid and vasoactive drug treatment between before and after knowing the EVLW value.
We studied 42 patients. After knowing the EVLW, 52.4% (n = 22) of initial therapeutic plans were changed, modifying fluid therapy in all of these cases and vasoactive therapy in 22% of them. EVLW value was 13.91 +/- 5.62 in patients with change of therapeutic plan versus 10 +/- 4.52 in those with no change (p < 0.05). No differences were found in preload parameters as a function of change/no change. The most frequent decision change (n = 13) was to fluid reduction plus diuretic administration, and patients with this modification had significantly (p < 0.05) higher EVLW values compared with the remaining patients with a change in fluid therapy. Out of the 22 patients with a modified therapeutic decision, the therapy proved effective in 18 patients
Quantification of EVLW in patients who can be considered euvolemic induces important modifications in fluid and vasoactive therapy. These changes generally resulted in a lower volume loading and a positive outcome for the patient.
复苏后阶段的前负荷参数对指导重症患者的液体治疗不够敏感。我们分析了在治疗方案中纳入血管外肺水（EVLW）数据后重症患者液体治疗和血管活性药物的变化，并评估了短期反应。
这项观察性前瞻性研究纳入了连续的低血压或低氧血症患者，比较了在知晓EVLW值前后的液体和血管活性药物治疗方案。
我们研究了42例患者。在知晓EVLW后，52.4%（n = 22）的初始治疗方案发生了改变，所有这些病例均改变了液体治疗，其中22%改变了血管活性治疗。治疗方案改变的患者EVLW值为13.91±5.62，未改变的患者为10±4.52（p < 0.05）。在前负荷参数方面，根据改变/未改变情况未发现差异。最常见的决策改变（n = 13）是减少液体量并加用利尿剂，与液体治疗改变的其余患者相比，有此改变的患者EVLW值显著更高（p < 0.05）。在22例治疗决策改变的患者中，治疗对18例患者有效。
对可视为血容量正常的患者进行EVLW定量可引起液体和血管活性治疗的重要改变。这些改变通常导致更低的容量负荷，并使患者获得良好结局。
