Cecconi M, Arulkumaran N, Kilic J, Ebm C, Rhodes A
Department of Intensive Care Medicine, St George's Hospital, London, UK -
Minerva Anestesiol. 2014 Jun;80(6):701-11. Epub 2013 Nov 26.
Severe sepsis and septic shock are associated with significant mortality. Effective management of this clinical syndrome includes early resuscitation with fluids and vasoactive drugs to maintain vital organ perfusion and oxygen delivery. Understanding the different approach to the management of sepsis during the resuscitation and ongoing management phases is essential to initiate context- and time-specific interventions. Manipulation of hemodynamic variables to achieve a balance between oxygen delivery and consumption forms the cornerstone of hemodynamic optimisation. Minimally invasive and completely non-invasive cardiac output monitors have been developed, but require validation in this specific cohort of patients. The trend in hemodynamic parameters is particularly important when any intervention to augment cardiac output is carried out (functional hemodynamic monitoring). Cardiac output monitors and surrogates of tissue oxygenation are only able to guide management, as patient outcome is determined by acquisition and interpretation of accurate data, and suitable management decisions.
严重脓毒症和脓毒性休克与显著的死亡率相关。对这种临床综合征的有效管理包括早期使用液体和血管活性药物进行复苏，以维持重要器官灌注和氧输送。了解在复苏和持续管理阶段脓毒症管理的不同方法对于启动针对具体情况和特定时间的干预措施至关重要。通过操纵血流动力学变量以实现氧输送和氧消耗之间的平衡是血流动力学优化的基石。已经开发出了微创和完全无创的心输出量监测仪，但需要在这一特定患者群体中进行验证。当进行任何增加心输出量的干预措施时（功能性血流动力学监测），血流动力学参数的趋势尤为重要。心输出量监测仪和组织氧合替代指标仅能指导管理，因为患者的预后取决于准确数据的获取和解读以及合适的管理决策。
