1 Department of Physiology, Universidad Nacional De Colombia, Bogota, Colombia.
2 Department of Anesthesiology, Centro Policlínico del Olaya, Bogota, Colombia.
J Intensive Care Med. 2018 Apr;33(4):227-240. doi: 10.1177/0885066617709434. Epub 2017 May 16.
Management with intravenous fluids can improve cardiac output in some surgical patients. Management with static preload indicators, such as central venous pressure and pulmonary artery occlusion pressure, has not demonstrated a suitable relationship with changes in the cardiac output induced by intravenous fluid therapy. Dynamic indicators, such as the variability of arterial pulse pressure or stroke volume variation, have demonstrated a suitable relationship. Since improvement in cardiac output does not guarantee an adequate perfusion pressure, in patients with hypotension, it is also necessary to know whether arterial pressure will also increase with intravenous fluid therapy. In this regard, the functional assessment of arterial load by dynamic arterial elastance could help to determine which patients will improve not only their cardiac output but also their mean arterial pressure.
静脉输液治疗可改善部分外科患者的心输出量。以中心静脉压和肺动脉嵌压等静态前负荷指标进行管理,与静脉输液治疗引起的心输出量变化之间并无合适的关联。而诸如动脉脉搏压变异或每搏量变异等动态指标则显示出合适的关联。由于心输出量的改善并不保证有足够的灌注压,因此对于低血压患者,还需要了解静脉输液治疗是否也会使动脉压升高。在这方面,通过动态动脉顺应性对动脉负荷的功能评估有助于确定哪些患者不仅心输出量会改善,而且平均动脉压也会改善。