Medical Resuscitation Service, Hospital of Bicêtre, University Hospital of Paris-Sud, Le Kremlin-Bicêtre, France.
Inserm UMR S_999, University of Paris-Sud, Le Kremlin-Bicêtre, France.
Minerva Anestesiol. 2018 Aug;84(8):987-992. doi: 10.23736/S0375-9393.18.12422-9. Epub 2018 Feb 14.
The prognosis of septic shock is tightly linked to the earliness of both appropriate antibiotic therapy and early hemodynamic resuscitation. This latter is essentially based on fluid and vasopressors administration. The step-by-step strategy, called "early goal-directed therapy" (EGDT) developed in 2001 and endorsed by the Surviving Sepsis Campaign (SSC) between 2004 and 2016 is no longer recommended. Indeed, recent multicenter randomized clinical trials showed no reduction in all-cause mortality, duration of organ support and in-hospital length of stay with EGDT in comparison with standard care. The most recent SCC guidelines have dropped the original EGDT by deleting the central venous pressure and the central venous oxygen saturation from the recommendations. Dynamic variables of fluid responsiveness are now recommended to be used after an initial fluid infusion of a fixed volume (30 mL/kg) during the first three hours of resuscitation. However, this approach is also questionable due to the lack of individualization at the early and crucial phase of resuscitation. In this review, we propose a more personalized approach for the early and later phases of fluid resuscitation during sepsis.
感染性休克的预后与适当抗生素治疗和早期血流动力学复苏的及时性密切相关。后者主要基于液体和血管加压药物的应用。2001 年提出的逐步策略，即“早期目标导向治疗”（EGDT），并在 2004 年至 2016 年期间得到了拯救脓毒症运动（SSC）的认可，但不再被推荐。事实上，最近的多中心随机临床试验表明，与标准治疗相比，EGDT 并没有降低所有原因的死亡率、器官支持的持续时间和住院时间。最新的 SCC 指南通过删除推荐中的中心静脉压和中心静脉血氧饱和度，放弃了最初的 EGDT。现在建议在复苏的头 3 小时内初始液体输注固定容量（30ml/kg）后使用液体反应性的动态变量。然而，由于在复苏的早期和关键阶段缺乏个体化，这种方法也存在疑问。在这篇综述中，我们提出了一种在感染性休克期间早期和后期更个体化的液体复苏方法。
