Johnson Alexander, Ahrens Thomas
Alexander Johnson is a clinical nurse specialist, Central DuPage Hospital, Cadence Health System-Northwestern Medicine, Winfield, Illinois.Thomas Ahrens is a research scientist, Barnes-Jewish Hospital, St Louis, Missouri.
Crit Care Nurse. 2015 Feb;35(1):11-27. doi: 10.4037/ccn2015427.
Critical care practices have evolved to rely more on physical assessments for monitoring cardiac output and evaluating fluid volume status because these assessments are less invasive and more convenient to use than is a pulmonary artery catheter. Despite this trend, level of consciousness, central venous pressure, urine output, heart rate, and blood pressure remain assessments that are slow to be changed, potentially misleading, and often manifested as late indications of decreased cardiac output. The hemodynamic optimization strategy called stroke volume optimization might provide a proactive guide for clinicians to optimize a patient's status before late indications of a worsening condition occur. The evidence supporting use of the stroke volume optimization algorithm to treat hypovolemia is increasing. Many of the cardiac output monitor technologies today measure stroke volume, as well as the parameters that comprise stroke volume: preload, afterload, and contractility.
重症监护实践已逐渐更多地依赖体格检查来监测心输出量和评估液体容量状态，因为与肺动脉导管相比，这些检查侵入性较小且使用更方便。尽管有这种趋势，但意识水平、中心静脉压、尿量、心率和血压仍然是改变缓慢、可能产生误导且常表现为心输出量降低的晚期指标的评估方法。称为每搏量优化的血流动力学优化策略可能为临床医生提供一个前瞻性指南，以便在病情恶化的晚期迹象出现之前优化患者的状态。支持使用每搏量优化算法治疗低血容量的证据正在增加。如今许多心输出量监测技术都能测量每搏量以及构成每搏量的参数：前负荷、后负荷和收缩力。
