Vincent Jean-Louis, Orbegozo Cortés Diego, Acheampong Angela
Erasme University Hospital, université libre de Bruxelles, Department of Intensive Care, route de Lennik 808, 1070 Brussels, Belgium.
Erasme University Hospital, université libre de Bruxelles, Department of Intensive Care, route de Lennik 808, 1070 Brussels, Belgium.
Presse Med. 2016 Apr;45(4 Pt 2):e99-e103. doi: 10.1016/j.lpm.2016.03.005. Epub 2016 Apr 11.
Early and adequate resuscitation of patients with acute circulatory failure is important to restore the balance between oxygen needs and delivery. Haemodynamic management can globally be separated into three categories according to the VIP mnemonic - Ventilate, Infuse, Pump - which should be considered simultaneously in the patient with shock. Sufficient oxygen should be given early, and endotracheal intubation and mechanical ventilation performed without hesitation if there is any indication that oxygenation is inadequate. Fluids should be administered using the SOSD mnemonic - Salvage, Optimization, Stabilization, De-escalation. After initial liberal administration, ongoing requirements should be guided by repeated fluid challenges using a combination of balanced crystalloid solutions and colloid. Noradrenaline is the vasopressor of choice and should be started early. Dobutamine may be needed to improve myocardial contractility and cardiac output. Haemodynamic support should be personalized according to individual patient characteristics and global and regional parameters of haemodynamic and oxygenation status.
对急性循环衰竭患者进行早期充分复苏对于恢复氧供需平衡至关重要。根据VIP记忆法，血流动力学管理总体上可分为三类——通气、输液、泵血——对于休克患者应同时考虑这三个方面。应尽早给予充足的氧气，如果有任何迹象表明氧合不足，应毫不犹豫地进行气管插管和机械通气。应使用SOSD记忆法进行液体管理——挽救、优化、稳定、降级。在初始大量补液后，持续的液体需求应以平衡晶体溶液和胶体联合进行反复补液试验为指导。去甲肾上腺素是首选的血管升压药，应尽早开始使用。可能需要多巴酚丁胺来改善心肌收缩力和心输出量。血流动力学支持应根据患者个体特征以及血流动力学和氧合状态的整体和局部参数进行个体化调整。
