Douglas James J, Walley Keith R
Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Curr Opin Crit Care. 2014 Aug;20(4):378-84. doi: 10.1097/MCC.0000000000000116.
We discuss the goals of resuscitation, in both the early and the later phases, measures of organ perfusion, fluid responsiveness and the consequences of tissue edema.
The cost of over-aggressive fluid resuscitation is increased organ failure and mortality. In anticipation of the upcoming trials on early goal-directed therapy, we explore strategies to maximize effectiveness of resuscitation. Furthermore, we review recent data on the choice of fluid therapy.
Rapid diagnosis and early fluid resuscitation are crucial to patients with septic shock, initially with the primary goal to relieve the overt tissue hypoxia. Early fluid therapy is important with the caveat that patients must show an increase in their cardiac output. Beyond 6-12 h further positive fluid balance may not usefully improve tissue oxygenation and may be counterproductive.
我们讨论复苏在早期和后期阶段的目标、器官灌注的测量、液体反应性以及组织水肿的后果。
过度积极的液体复苏会增加器官衰竭和死亡率。鉴于即将开展的早期目标导向治疗试验，我们探索使复苏效果最大化的策略。此外，我们回顾了近期关于液体治疗选择的数据。
快速诊断和早期液体复苏对感染性休克患者至关重要，最初的主要目标是缓解明显的组织缺氧。早期液体治疗很重要，但前提是患者的心输出量必须增加。超过6 - 12小时后，进一步的正液体平衡可能无法有效改善组织氧合，甚至可能适得其反。
