Department of Intensive Care, Alfred Hospital, and Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Alfred Centre, Commercial Road, Prahran, Melbourne, Victoria 3181, Australia.
Crit Care. 2012 Jan 25;16(1):302. doi: 10.1186/cc11154.
Resuscitation of septic patients by means of one or more fluid boluses is recommended by guidelines from multiple relevant organizations and as a component of surviving sepsis campaigns. The technique is considered a key and life-saving intervention during the initial treatment of severe sepsis in children and adults. Such recommendations, however, are only based on expert opinion and lack adequate experimental or controlled human evidence. Despite these limitations, fluid bolus therapy (20 to 40 ml/kg) is widely practiced and is currently considered a cornerstone of the management of sepsis. In this pointof-view critique, we will argue that such therapy has weak physiological support, has limited experimental support, and is at odds with emerging observational data in several subgroups of critically ill patients or those having major abdominal surgery. Finally, we will argue that this paradigm is now challenged by the findings of a large randomized controlled trial in septic children. In the present article, we contend that the concept of large fluid bolus resuscitation in sepsis needs to be investigated further.
复苏脓毒症患者通过一个或多个液体冲击是由多个相关组织的指南推荐的，作为拯救脓毒症运动的一个组成部分。该技术被认为是儿童和成人严重脓毒症初始治疗的关键和救生干预措施。然而，这些建议仅基于专家意见，缺乏足够的实验或对照人体证据。尽管存在这些局限性，液体冲击疗法（20 至 40 毫升/公斤）仍被广泛应用，目前被认为是脓毒症治疗的基石。在这篇观点评论中，我们将认为这种治疗方法的生理支持较弱，实验支持有限，并且与重症患者或接受大型腹部手术的患者的一些亚组的新出现的观察数据不一致。最后，我们将认为这一范例现在受到脓毒症儿童的一项大型随机对照试验结果的挑战。在本文中，我们认为需要进一步研究脓毒症中大量液体复苏的概念。
