aLaboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil bDepartment of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
Curr Opin Crit Care. 2014 Feb;20(1):104-12. doi: 10.1097/MCC.0000000000000049.
Fluid resuscitation in acute respiratory distress syndrome (ARDS) is not well documented. Clinical evidence comes from studies in critically ill patients, but these patients respond differently to fluids depending on the presence or absence of sepsis.
Clinical trials have shown adverse effects on kidney and hemostatic functions and trends toward increased mortality after hydroxyethyl starch infusion. Although well conducted, the methodology deserves attention concerning the infused volume, hemodynamic goals and the presence of septic and nonseptic patients. Small single-center studies have shown beneficial results associated with colloidal molecules through innovative methodological apparatus. Ongoing clinical trials allied to retrospective and prospective trials may favor the introduction of albumin in the critically ill population.
In order to evaluate the pros and cons of using fluids in ARDS patients, it is important to carefully analyze the latest trials. Recent studies have emphasized the importance of better understanding endothelial pathophysiology during fluid management in ARDS patients. Certainly, further studies analyzing fluid strategies in septic and nonseptic ARDS patients are needed.
急性呼吸窘迫综合征（ARDS）的液体复苏并没有得到很好的记录。临床证据来自于危重病患者的研究，但这些患者对液体的反应因是否存在败血症而不同。
临床试验显示羟乙基淀粉输注后对肾功能和止血功能有不良影响，并存在死亡率增加的趋势。尽管方法得当，但关于输注量、血流动力学目标以及脓毒症和非脓毒症患者的存在，该方法值得关注。小型单中心研究表明，通过创新的方法学设备，胶体分子具有有益的结果。正在进行的临床试验以及回顾性和前瞻性试验可能有利于在危重病患者中引入白蛋白。
为了评估在 ARDS 患者中使用液体的利弊，仔细分析最新的试验非常重要。最近的研究强调了在 ARDS 患者液体管理过程中更好地了解内皮生理病理的重要性。当然，还需要进一步研究分析脓毒症和非脓毒症 ARDS 患者的液体策略。
