Ince Can
Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Curr Opin Crit Care. 2014 Jun;20(3):301-8. doi: 10.1097/MCC.0000000000000091.
The ultimate purpose of fluid administration in states of hypovolemia is to correct cardiac output to improve microcirculatory perfusion and tissue oxygenation. Observation of the microcirculation using handheld microscopes gives insight into the nature of convective and diffusive defect in hypovolemia. The purpose of this article is to introduce a new platform for hemodynamic-targeted fluid therapy based on the correction of tissue and microcirculatory perfusion assumed to be at risk during hypovolemia.
Targeting systemic hemodynamic targets and/or clinical surrogates of hypovolemia gives inadequate guarantee for the correction of tissue perfusion by fluid therapy especially in conditions of distributive shock as occur in inflammation and sepsis. Findings are presented, which support the idea that only clinical signs of hypovolemia associated with low microcirculatory flow can be expected to benefit from fluid therapy and that fluid overload causes a defect in the diffusion of oxygen transport.
We hypothesized that the optimal amount of fluid needed for correction of hypovolemia is defined by a physiologically based functional microcirculatory hemodynamic platform where convection and diffusion need to be optimized. Future clinical trials using handheld microscopes able to automatically evaluate the microcirculation at the bedside will show whether such a platform will indeed optimize fluid therapy.
在低血容量状态下进行液体输注的最终目的是纠正心输出量，以改善微循环灌注和组织氧合。使用手持式显微镜观察微循环有助于深入了解低血容量状态下对流和扩散缺陷的本质。本文旨在介绍一种基于纠正低血容量期间可能存在风险的组织和微循环灌注的血流动力学靶向液体治疗新平台。
以全身血流动力学指标和/或低血容量的临床替代指标为目标，无法充分保证通过液体治疗纠正组织灌注，尤其是在炎症和脓毒症等分布性休克情况下。研究结果表明，只有与微循环血流低相关的低血容量临床体征有望从液体治疗中获益，且液体过载会导致氧输送扩散缺陷。
我们假设，纠正低血容量所需的最佳液体量由基于生理的功能性微循环血流动力学平台定义，在该平台上对流和扩散需要优化。未来使用能够在床边自动评估微循环的手持式显微镜进行的临床试验将表明，这样的平台是否真的能优化液体治疗。
