McCammond Amy N, Axelrod David M, Bailly David K, Ramsey E Zachary, Costello John M
1Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR. 2Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA. 3Division of Pediatric Critical Care, Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, UT. 4Department of Pharmacy, the Children's Hospital of Philadelphia, Philadelphia, PA. 5Division of Cardiology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
Pediatr Crit Care Med. 2016 Mar;17(3 Suppl 1):S35-48. doi: 10.1097/PCC.0000000000000633.
In this Consensus Statement, we review the etiology and pathophysiology of fluid disturbances in critically ill children with cardiac disease. Clinical tools used to recognize pathologic fluid states are summarized, as are the mechanisms of action of many drugs aimed at optimal fluid management.
The expertise of the authors and a review of the medical literature were used as data sources.
The authors synthesized the data in the literature in order to present clinical tools used to recognize pathologic fluid states. For each drug, the physiologic rationale, mechanism of action, and pharmacokinetics are synthesized, and the evidence in the literature to support the therapy is discussed.
Fluid management is challenging in critically ill pediatric cardiac patients. A myriad of causes may be contributory, including intrinsic myocardial dysfunction with its associated neuroendocrine response, renal dysfunction with oliguria, and systemic inflammation with resulting endothelial dysfunction. The development of fluid overload has been associated with adverse outcomes, including acute kidney injury, prolonged mechanical ventilation, increased vasoactive support, prolonged hospital length of stay, and mortality. An in-depth understanding of the many factors that influence volume status is necessary to guide optimal management.
在本共识声明中，我们回顾了患有心脏病的危重症儿童液体紊乱的病因和病理生理学。总结了用于识别病理性液体状态的临床工具，以及许多旨在实现最佳液体管理的药物的作用机制。
作者的专业知识和医学文献综述被用作数据来源。
作者综合了文献中的数据，以呈现用于识别病理性液体状态的临床工具。对于每种药物，综合了其生理原理、作用机制和药代动力学，并讨论了文献中支持该治疗方法的证据。
危重症小儿心脏病患者的液体管理具有挑战性。多种原因可能起作用，包括内在心肌功能障碍及其相关的神经内分泌反应、伴有少尿的肾功能障碍以及导致内皮功能障碍的全身炎症。液体超负荷的发生与不良后果相关，包括急性肾损伤、机械通气时间延长、血管活性支持增加、住院时间延长和死亡率。深入了解影响容量状态的诸多因素对于指导最佳管理至关重要。
