AP-HP, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service de Réanimation Médicale, Le Kremlin-Bicêtre F-94270, France.
Best Pract Res Clin Anaesthesiol. 2013 Jun;27(2):177-85. doi: 10.1016/j.bpa.2013.06.002.
Fluid therapy represents, most of the time, the first-line treatment of circulatory failure in critically ill patients. However, after initial resuscitation, fluid administration can be deleterious in patients with sepsis and/or acute respiratory distress syndrome. In this context, several tests have been developed to predict fluid responsiveness and fluid unresponsiveness to identify patients who can be eligible for fluid therapy (fluid respondents) and those who cannot benefit from volume expansion (fluid non-respondents) and in whom fluid loading can even be deleterious. For this purpose, 'static' markers of cardiac preload have been used for many years. However, a large number of studies clearly showed that neither pressure nor volume markers of cardiac preload could predict fluid responsiveness. This is the reason why a 'dynamic approach' has been developed to assess preload responsiveness. The respiratory variation of arterial pulse pressure and of other surrogates of stroke volume has been used first for this purpose and has received a large amount of evidence. However, such indices suffer from several limitations. In such instances, alternative methods such as passive leg raising, end-expiratory occlusion test or 'mini' fluid challenge have been developed.
液体治疗在大多数情况下是治疗危重症患者循环衰竭的一线治疗方法。然而，在初始复苏后，液体给药可能对脓毒症和/或急性呼吸窘迫综合征患者有害。在这种情况下，已经开发了几种测试来预测液体反应性和液体无反应性，以识别可以接受液体治疗的患者（液体应答者）和不能从容量扩张中获益的患者（液体无应答者），并且在这些患者中，液体负荷甚至可能有害。为此，多年来一直使用“静态”的心脏前负荷标志物。然而，大量研究清楚地表明，心脏前负荷的压力或容量标志物均不能预测液体反应性。这就是为什么开发了“动态”方法来评估前负荷反应性的原因。为此，首先使用了动脉脉搏压和其他每搏量替代指标的呼吸变化，并得到了大量证据。然而，这些指标存在多种局限性。在这种情况下，已经开发了替代方法，如被动抬腿、呼气末阻断试验或“迷你”液体挑战。
