Department of Critical Care Medicine, Marmara University School of Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey.
Division of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA.
J Crit Care. 2020 Jun;57:108-117. doi: 10.1016/j.jcrc.2020.02.004. Epub 2020 Feb 11.
Septic shock is the most severe form of sepsis, characterized by (a) persistent hypotension despite fluid resuscitation and (b) the presence of tissue hypoperfusion. Delays in the diagnosis and initiation of treatment of septic shock is associated with increasing risk for mortality. Early and effective fluid resuscitation and vasopressor administration play a crucial role in maintaining tissue perfusion in septic shock patients. A low diastolic arterial pressure (DAP) correlates with severity of arteriolar vasodilation, compromises left ventricle oxygen supply and can be used for identifying septic shock patients that would potentially benefit from earlier vasopressor therapy. Controversy currently exists as to the balance of fluids and vasopressors to maintain target mean arterial pressure. The aim of this article is to review the rationale for fluid resuscitation and vasopressor therapy and the importance of both mean and diastolic blood pressure during the initial resuscitation of the septic shock. We relate our personal prescription of balancing fluids and vasopressors in the resuscitation of septic shock.
感染性休克是败血症最严重的形式，其特征为：（a）尽管进行了液体复苏，仍持续存在低血压；（b）存在组织低灌注。延迟诊断和开始治疗感染性休克与死亡率的增加相关。早期和有效的液体复苏以及血管加压素的应用在维持感染性休克患者的组织灌注方面发挥着关键作用。低舒张期动脉压（DAP）与小动脉扩张的严重程度相关，损害左心室的氧供，并可用于识别可能从早期血管加压素治疗中获益的感染性休克患者。目前，关于维持目标平均动脉压所需的液体和血管加压素的平衡存在争议。本文的目的是回顾液体复苏和血管加压素治疗的基本原理，以及在感染性休克初始复苏期间平均血压和舒张压的重要性。我们阐述了我们在感染性休克复苏中平衡液体和血管加压素的个人处方。
