Department of Intensive Care, Erasmus MC - University Medical Center, Rotterdam, The Netherlands.
Department of Pulmonology and Critical Care, New York University NYU Langone Medical Center.
Curr Opin Crit Care. 2021 Jun 1;27(3):269-273. doi: 10.1097/MCC.0000000000000826.
Current goals of resuscitation in septic shock are mainly a fixed volume of fluids and vasopressors to correct hypotension and improve tissue perfusion indicated by decreasing lactate levels.
Abnormal peripheral perfusion by objective and subjective parameters are associated with increased mortality in various phases of the treatment of critically ill patients including patients with septic shock. Ongoing resuscitation in septic shock patients with normal peripheral perfusion is not associated with improved outcome, rather with increased mortality. Mitigation of fluid resuscitation by using parameters of peripheral perfusion in septic shock seems to be safe.
Septic shock patients with normal peripheral perfusion represent a different clinical phenotype of patients that might benefit from limited resuscitation efforts. Parameters of peripheral perfusion could be used to guide the individualization of patients with septic shock.
目前,脓毒性休克复苏的主要目标是通过固定的液体量和升压药来纠正低血压,并通过降低乳酸水平来改善组织灌注。
客观和主观参数显示的外周灌注异常与各种危重病患者(包括脓毒性休克患者)治疗阶段的死亡率增加有关。对正常外周灌注的脓毒性休克患者进行持续复苏与改善预后无关,反而与死亡率增加有关。通过使用脓毒性休克外周灌注参数来减轻液体复苏似乎是安全的。
正常外周灌注的脓毒性休克患者代表了一种不同的临床表型,可能受益于有限的复苏努力。外周灌注参数可用于指导脓毒性休克患者的个体化治疗。