Department of Pharmacy, University of Kentucky, Lexington, Kentucky.
College of Pharmacy, Pharmacy Practice and Science, University of Kentucky, Lexington, Kentucky.
Shock. 2021 Oct 1;56(4):484-492. doi: 10.1097/SHK.0000000000001783.
We sought to review the pharmacology of vasoactive therapy and fluid administration in sepsis and septic shock, with specific insight into the physiologic interplay of these agents. A PubMed/MEDLINE search was conducted using the following terms (vasopressor OR vasoactive OR inotrope) AND (crystalloid OR colloid OR fluid) AND (sepsis) AND (shock OR septic shock) from 1965 to October 2020. A total of 1,022 citations were reviewed with only relevant clinical data extracted. While physiologic rationale provides a hypothetical foundation for interaction between fluid and vasopressor administration, few studies have sought to evaluate the clinical impact of this synergy. Current guidelines are not in alignment with the data available, which suggests a potential benefit from low-dose fluid administration and early vasopressor exposure. Future data must account for the impact of both of these pharmacotherapies when assessing clinical outcomes and should assess personalization of therapy based on the possible interaction.
我们旨在回顾脓毒症和感染性休克中血管活性治疗和液体管理的药理学，特别关注这些药物的生理相互作用。使用以下术语（血管加压药或血管活性药或正性肌力药）和（晶体液或胶体液或液体）和（脓毒症）和（休克或感染性休克），对 1965 年至 2020 年 10 月期间的 PubMed/MEDLINE 进行了搜索。共审查了 1022 条引用，仅提取了相关的临床数据。虽然生理原理为液体和血管加压药给药之间的相互作用提供了假设基础，但很少有研究试图评估这种协同作用的临床影响。目前的指南与现有数据不一致，这表明从小剂量液体管理和早期血管加压药暴露中可能获益。未来的数据在评估临床结果时必须考虑到这两种药物治疗的影响，并根据可能的相互作用评估治疗的个体化。
