Center of Anesthesiology and Intensive Care Medicine, Department of Anesthesiology, Hamburg-Eppendorf University Medical Center Martinistraße 52, 20246 Hamburg, Germany.
Ann Intensive Care. 2011 Mar 21;1(1):2. doi: 10.1186/2110-5820-1-2.
Fluid and volume therapy is an important cornerstone of treating critically ill patients in the intensive care unit and in the operating room. New findings concerning the vascular barrier, its physiological functions, and its role regarding vascular leakage have lead to a new view of fluid and volume administration. Avoiding hypervolemia, as well as hypovolemia, plays a pivotal role when treating patients both perioperatively and in the intensive care unit. The various studies comparing restrictive vs. liberal fluid and volume management are not directly comparable, do not differ (in most instances) between colloid and crystalloid administration, and mostly do not refer to the vascular barrier's physiologic basis. In addition, very few studies have analyzed the use of advanced hemodynamic monitoring for volume management.This article summarizes the current literature on the relevant physiology of the endothelial surface layer, discusses fluid shifting, reviews available research on fluid management strategies and the commonly used fluids, and identifies suitable variables for hemodynamic monitoring and their goal-directed use.
液体和容量治疗是重症监护病房和手术室治疗危重病患者的重要基石。关于血管屏障及其生理功能以及其在血管渗漏方面的作用的新发现，导致了对液体和容量管理的新观点。在围手术期和重症监护病房治疗患者时，避免血容量过多和血容量不足都起着关键作用。比较限制与自由液体和容量管理的各种研究并不完全可比，在大多数情况下，胶体和晶体的给药也没有差异，并且大多数都没有提到血管屏障的生理基础。此外，很少有研究分析使用先进的血流动力学监测进行容量管理。本文总结了有关内皮表面层相关生理学的最新文献，讨论了液体转移，回顾了现有的液体管理策略和常用液体的研究，并确定了适合血流动力学监测的合适变量及其目标导向使用。
