Goldstein S, Bagshaw S, Cecconi M, Okusa M, Wang H, Kellum J, Mythen M, Shaw A D
Center for Acute Care Nephrology, Nephrology and Hypertension, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7022, RILF2, Cincinnati, OH 45229, USA
University of Alberta, Edmonton, Canada.
Br J Anaesth. 2014 Nov;113(5):756-63. doi: 10.1093/bja/aeu299. Epub 2014 Sep 10.
Standard treatment practice for the hypotensive patient with poor tissue perfusion is rapid volume resuscitation; in some scenarios, such as septic shock, this is performed with targeted goal-directed endpoints within 6 h of presentation. As a result, patients often develop significant positive fluid accumulation, which has been associated with poor outcomes above certain thresholds.
The aim of the current paper is to provide guidance for active pharmacological fluid management in the patient with, or at risk for, clinically significant positive fluid balance from either resuscitation for hypovolaemic shock or acute decompensated heart failure.
We develop rationale for pharmacological fluid management targets (prevention of worsening fluid accumulation, achievement of slow vs rapid net negative fluid balance) in the context of phases of critical illness provided in the earlier Acute Dialysis Quality Initiative 12 papers.
对于组织灌注不良的低血压患者，标准治疗方法是快速进行容量复苏；在某些情况下，如感染性休克，需在就诊后6小时内以目标导向终点进行。结果，患者常出现明显的正性液体蓄积，超过一定阈值时与不良预后相关。
本文旨在为患有或有临床显著正性液体平衡风险的患者提供积极的药物性液体管理指导，这些患者因低血容量性休克复苏或急性失代偿性心力衰竭而处于这种情况。
我们在早期急性透析质量倡议12篇论文中所提供的危重病阶段背景下，阐述了药物性液体管理目标（预防液体蓄积恶化、实现缓慢与快速净负液体平衡）的基本原理。
