Virág Marcell, Leiner Tamas, Rottler Mate, Ocskay Klementina, Molnar Zsolt
Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary.
Szent György University Teaching Hospital of Fejér County, 8000 Székesfehérvár, Hungary.
J Pers Med. 2021 Feb 23;11(2):157. doi: 10.3390/jpm11020157.
Hemodynamic optimization remains the cornerstone of resuscitation in the treatment of sepsis and septic shock. Delay or inadequate management will inevitably lead to hypoperfusion, tissue hypoxia or edema, and fluid overload, leading eventually to multiple organ failure, seriously affecting outcomes. According to a large international survey (FENICE study), physicians frequently use inadequate indices to guide fluid management in intensive care units. Goal-directed and "restrictive" infusion strategies have been recommended by guidelines over "liberal" approaches for several years. Unfortunately, these "fixed regimen" treatment protocols neglect the patient's individual needs, and what is shown to be beneficial for a given population may not be so for the individual patient. However, applying multimodal, contextualized, and personalized management could potentially overcome this problem. The aim of this review was to give an insight into the pathophysiological rationale and clinical application of this relatively new approach in the hemodynamic management of septic patients.
血流动力学优化仍然是脓毒症和脓毒性休克治疗中复苏的基石。延迟或管理不当将不可避免地导致灌注不足、组织缺氧或水肿以及液体超负荷，最终导致多器官功能衰竭，严重影响治疗结果。根据一项大型国际调查（FENICE研究），医生在重症监护病房中经常使用不充分的指标来指导液体管理。多年来，指南推荐目标导向和“限制性”输液策略，而非“自由”策略。不幸的是，这些“固定方案”治疗方案忽视了患者的个体需求，对特定人群有益的方法对个体患者可能并非如此。然而，应用多模式、情境化和个性化管理可能会克服这一问题。本综述的目的是深入了解这种相对较新的方法在脓毒症患者血流动力学管理中的病理生理原理和临床应用。
