Lobo Suzana Margareth Ajeje, Rezende Ederlon, Mendes Ciro Leite, Rea-Neto Alvaro, David Cid Marcos, Dias Fernando Suparregui, Schettino Guilherme
Rev Bras Ter Intensiva. 2006 Jun;18(2):161-76.
Shock occurs when the circulatory system cannot maintain adequate cellular perfusion. If this condition is not reverted irreversible cellular injury establishes. Shock treatment has as its initial priority the fast and vigorous correction of mean arterial pressure and cardiac output to maintain life and avoid or lessen organic dysfunctions. Fluid challenge and vasoactive drugs are necessary to warrant an adequate tissue perfusion and maintenance of function of different organs and systems, always guided by cardiovascular monitorization. The recommendations built in this consensus are aimed to guide hemodynamic support needed to maintain adequate tisular perfusion.
Modified Delphi methodology was used to create and quantify the consensus between the participants. AMIB indicated a coordinator who invited more six experts in the area of monitoring and hemodynamic support to constitute the Consensus Advisory Board. Twenty five physician and two nurses selected from different regions of the country completed the expert panel, which reviewed the pertinent bibliography listed at the MEDLINE in the period from 1996 to 2004.
Recommendations were made answering 17 questions about hemodynamic support with focus on fluid challenge, red blood cell transfusions, vasoactive drugs and perioperative hemodynamic optimization.
Hemodynamic monitoring by itself does not reduce the mortality of critically ill patients, however, we believe that the correct interpretation of the data obtained by the hemodynamic monitoring and the use of hemodynamic support protocols based on well defined tissue perfusion goals can improve the outcome of these patients.
当循环系统无法维持足够的细胞灌注时，就会发生休克。如果这种情况得不到逆转，就会导致不可逆的细胞损伤。休克治疗的首要任务是迅速有力地纠正平均动脉压和心输出量，以维持生命并避免或减轻器官功能障碍。液体冲击和血管活性药物对于保证充足的组织灌注以及维持不同器官和系统的功能是必要的，始终以心血管监测为指导。本共识中提出的建议旨在指导维持充足组织灌注所需的血流动力学支持。
采用改良德尔菲法在参与者之间达成并量化共识。阿根廷重症监护医学协会指定了一名协调员，邀请另外六位监测和血流动力学支持领域的专家组成共识咨询委员会。从该国不同地区选出的25名医生和2名护士组成了专家小组，该小组查阅了1996年至2004年期间MEDLINE上列出的相关文献。
针对17个关于血流动力学支持的问题提出了建议，重点是液体冲击、红细胞输注、血管活性药物和围手术期血流动力学优化。
血流动力学监测本身并不能降低重症患者的死亡率，然而，我们认为正确解读血流动力学监测获得的数据，并使用基于明确组织灌注目标的血流动力学支持方案，可以改善这些患者的预后。
