Champion S, Deye N
Réanimation médicale et toxicologique, hôpital Lariboisière, 2, rue A.-Paré, 75010 Paris, France; Réanimation, clinique de Parly 2, Ramsay générale de santé, 21, rue Moxouris, 78150 Le Chesnay, France.
Réanimation médicale et toxicologique, hôpital Lariboisière, 2, rue A.-Paré, 75010 Paris, France.
Ann Cardiol Angeiol (Paris). 2017 Apr;66(2):59-65. doi: 10.1016/j.ancard.2016.10.013. Epub 2016 Nov 9.
Physician survey on cardiogenic shock management; recommendations for the management of patients with cardiogenic shock are based mostly on experts' opinion.
Overall 1585 emails were sent to "senior" intensive care physicians from France and Belgium from September 2014 to march 2015. Response rate was 10% (157 respondents). Agreement was assessed based on RAND/UCLA methodology.
Continuous monitoring of cardiac output, vascular filling, noninvasive ventilation were deemed appropriate. The use of systematic diuretics and dopamine seemed inappropriate. There was a strong agreement to use dobutamine as inotropic drug in first intention. The use of noradrenaline and adrenaline was considered appropriate. There was a strong agreement to use mechanical circulatory support, in particular extracorporeal life support, in refractory cardiogenic shock. Only 25% of responders felt that there are criteria of refractory cardiogenic shock. Concerning the objectives of systolic, diastolic and mean blood pressure, 95% of the responses were in the range between 70 to 100, 30 to 50, and 55 to 65mmHg, respectively. The target of SvO was between 55% and 75%, and cardiac index between 1.5 and 3L/min/m for 95% of responders. There was a strong agreement to maintain hemoglobin between 7 and 9.9g/dL.
Based on our physician survey, we found an agreement in vascular filling and early enteral nutrition. Dobutamine and noradrenaline should be the preferred drugs, but not dopamine. Mechanical circulatory support (preferably with extracorporeal support) should be restricted to refractory cardiogenic shock. Those responses differed slightly from experts' opinion, available in terms of recommendations.
开展关于心源性休克管理的医生调查；心源性休克患者管理建议大多基于专家意见。
2014年9月至2015年3月期间，共向法国和比利时的“资深”重症监护医生发送了1585封电子邮件。回复率为10%（157名受访者）。根据兰德/加州大学洛杉矶分校方法评估一致性。
连续监测心输出量、血管充盈情况、无创通气被认为是合适的。系统性使用利尿剂和多巴胺似乎不合适。强烈一致同意首选多巴酚丁胺作为正性肌力药物。去甲肾上腺素和肾上腺素的使用被认为是合适的。强烈一致同意在难治性心源性休克中使用机械循环支持，尤其是体外生命支持。只有25%的受访者认为存在难治性心源性休克的标准。关于收缩压、舒张压和平均血压目标，95%的回复分别在70至100mmHg、30至50mmHg和55至65mmHg范围内。95%的受访者的SvO₂目标在55%至75%之间，心脏指数在1.5至3L/min/m²之间。强烈一致同意将血红蛋白维持在7至9.9g/dL之间。
基于我们的医生调查，我们发现在血管充盈和早期肠内营养方面存在一致性。多巴酚丁胺和去甲肾上腺素应作为首选药物，而非多巴胺。机械循环支持（最好是体外支持）应仅限于难治性心源性休克。这些回复与现有建议中的专家意见略有不同。
