Jedlicka Jan, Jacob Matthias, Chappell Daniel
Anasthesiol Intensivmed Notfallmed Schmerzther. 2021 Apr;56(4):232-245. doi: 10.1055/a-1118-7461. Epub 2021 Apr 22.
A rational infusion therapy orchestrates fluid- and volume therapy based on the individual indication and situation. The principle of fluid replacement is to substitute ongoing fluid losses such as insensible perspiration and urine output or to treat dehydration with balanced crystalloid solutions. Volume therapy in contrast is the quick restoration of intravascular losses such as an acute blood loss through application of balanced colloids or crystalloids. The goal of volume therapy is to maintain normal cardiac output and oxygen delivery by restoring intravascular normovolemia and cardiac preload. Whether colloid or crystalloid infusions are most suitable for volume therapy remains unclear. Most trials in this field are either underpowered or used colloids in inadequate situations, patients and amounts. Two major trials from the European Society of Anaesthesiology and Intensive Care (ESAIC) are underway that seem promising to provide evidence in this emotional debate.
合理的输液治疗是根据个体指征和情况来协调液体和容量治疗。液体补充的原则是补充持续的液体丢失,如不显性出汗和尿量,或用平衡晶体溶液治疗脱水。相比之下,容量治疗是通过应用平衡胶体或晶体迅速恢复血管内容量丢失,如急性失血。容量治疗的目标是通过恢复血管内正常血容量和心脏前负荷来维持正常的心输出量和氧输送。胶体或晶体输注是否最适合容量治疗仍不清楚。该领域的大多数试验要么样本量不足,要么在不适当的情况、患者和剂量下使用胶体。欧洲麻醉学和重症监护学会(ESAIC)正在进行两项主要试验,似乎有望在这场激烈的争论中提供证据。