Byrne Liam, Van Haren Frank
Australian National University Medical School, Canberra, Australia.
Intensive Care Unit, The Canberra Hospital, Canberra, Australia.
Ann Intensive Care. 2017 Dec;7(1):4. doi: 10.1186/s13613-016-0231-8. Epub 2017 Jan 3.
Fluid resuscitation continues to be recommended as the first-line resuscitative therapy for all patients with severe sepsis and septic shock. The current acceptance of the therapy is based in part on long history and familiarity with its use in the resuscitation of other forms of shock, as well as on an incomplete and incorrect understanding of the pathophysiology of sepsis. Recently, the safety of intravenous fluids in patients with sepsis has been called into question with both prospective and observational data suggesting improved outcomes with less fluid or no fluid. The current evidence for the continued use of fluid resuscitation for sepsis remains contentious with no prospective evidence demonstrating benefit to fluid resuscitation as a therapy in isolation. This article reviews the historical and physiological rationale for the introduction of fluid resuscitation as treatment for sepsis and highlights a number of significant concerns based on current experimental and clinical evidence. The research agenda should focus on the development of hyperdynamic animal sepsis models which more closely mimic human sepsis and on experimental and clinical studies designed to evaluate minimal or no fluid strategies in the resuscitation phase of sepsis.
对于所有严重脓毒症和脓毒性休克患者，液体复苏仍被推荐为一线复苏治疗方法。目前对该疗法的认可部分基于其悠久的历史以及在其他形式休克复苏中的广泛应用，同时也基于对脓毒症病理生理学的不完整且错误的理解。最近，脓毒症患者静脉输液的安全性受到质疑，前瞻性和观察性数据均表明，减少液体用量或不进行液体治疗可改善预后。目前关于继续将液体复苏用于脓毒症治疗的证据仍存在争议，尚无前瞻性证据表明单纯将液体复苏作为一种治疗方法能带来益处。本文回顾了将液体复苏引入脓毒症治疗的历史和生理依据，并基于当前的实验和临床证据突出了一些重大问题。研究议程应聚焦于开发更接近人类脓毒症的高动力性动物脓毒症模型，以及旨在评估脓毒症复苏阶段最小化或无液体策略的实验和临床研究。
