O'Connor Michael E, Jones Sarah L, Glassford Neil J, Bellomo Rinaldo, Prowle John R
Adult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, London, UK.
Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK.
J Intensive Care Soc. 2017 Nov;18(4):282-288. doi: 10.1177/1751143717699423. Epub 2017 Jun 13.
To identify and compare how intensive care unit specialists in the United Kingdom and Australia and New Zealand self-reportedly define, assess and manage fluid overload in critically ill patients using a structured online questionnaire.
We assessed 219 responses. Australia and New Zealand and United Kingdom intensive care unit specialists reported using clinical examination findings, bedside tools and radiological features to assess fluid status, diagnose fluid overload and initiate fluid removal in the critically ill. An elevated central venous pressure is not regarded as helpful in diagnosing fluid overload and targeting a clinician-set fluid balance is the most popular management strategy. Renal replacement therapy is used ahead of more diuretic therapy in patients who are oligo/anuric, or when diuretic therapy has not generated an adequate response.
This self-reported account of practice by United Kingdom and Australia and New Zealand intensivists demonstrates that fluid overload remains poorly defined with variability in both management and practice.
使用结构化在线问卷，识别并比较英国、澳大利亚和新西兰的重症监护病房专家如何自述定义、评估和管理重症患者的液体超负荷情况。
我们评估了219份回复。澳大利亚和新西兰以及英国的重症监护病房专家报告称，他们使用临床检查结果、床边工具和影像学特征来评估液体状态、诊断液体超负荷并在重症患者中启动液体清除。中心静脉压升高在诊断液体超负荷方面不被认为有帮助，以临床医生设定的液体平衡为目标是最常用的管理策略。在少尿/无尿患者中，或利尿剂治疗未产生充分反应时，会在更多利尿剂治疗之前使用肾脏替代疗法。
英国、澳大利亚和新西兰重症监护医生对实践的这种自述表明，液体超负荷的定义仍然不明确，管理和实践存在差异。
