Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
Shock. 2018 Jan;49(1):15-23. doi: 10.1097/SHK.0000000000000929.
Far from traditional "vital signs," the field of hemodynamic monitoring (HM) is rapidly developing. However, it is also easy to misunderstand hemodynamic therapy as merely HM and some concrete bundles or guidelines for circulation support. Here, we describe the concept of "critical hemodynamic therapy" and clarify the concepts of the "therapeutic target" and "therapeutic endpoint" in clinical practice. Three main targets (oxygen delivery, blood flow, perfusion pressure) for resuscitation are reviewed in critically ill patients according to the sepsis guidelines and hemodynamic consensus. ScvO2 at least 70% has not been recommended as a directed target for initial resuscitation, and the directed target of mean arterial pressure (MAP) still is 65 mmHg. Moreover, the individual MAP target is underlined, and using flow-dependent monitoring to guide fluid infusion is recommended. The flow-directed target for fluid infusion might be a priority, but it remains controversial in resuscitation. The interpretation of these targets is necessary for adequate resuscitation and the correction of tissue hypoxia. The incoherence phenomenon of resuscitation (macrocirculation and microcirculation, tissue perfusion, and cellular oxygen utilization) is gaining increased attention, and early identification of these incoherences might be helpful to reduce the risk of over-resuscitation.
远非传统的“生命体征”，血流动力学监测（HM）领域正在迅速发展。然而，人们也容易将血流动力学治疗误解为仅仅是 HM 和一些具体的循环支持包或指南。在这里，我们描述了“关键血流动力学治疗”的概念，并阐明了临床实践中的“治疗目标”和“治疗终点”的概念。根据脓毒症指南和血流动力学共识，我们回顾了危重症患者复苏的三个主要目标（氧输送、血流、灌注压）。至少 70%的 ScvO2 并未被推荐作为初始复苏的靶向目标，而平均动脉压（MAP）的靶向目标仍然是 65mmHg。此外，强调了个体 MAP 目标，并建议使用流量依赖性监测来指导液体输注。流量导向的液体输注目标可能是首要目标，但在复苏中仍存在争议。这些目标的解释对于充分复苏和纠正组织缺氧是必要的。复苏的不协调现象（大循环和微循环、组织灌注和细胞氧利用）越来越受到关注，早期识别这些不协调可能有助于降低过度复苏的风险。
