Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Clin J Am Soc Nephrol. 2022 May;17(5):706-716. doi: 10.2215/CJN.14191021. Epub 2022 Apr 4.
One of the primary reasons for intensive care admission is shock. Identifying the underlying cause of shock (hypovolemic, distributive, cardiogenic, and obstructive) may lead to entirely different clinical pathways for management. Among patients with hypovolemic and distributive shock, fluid therapy is one of the leading management strategies. Although an appropriate amount of fluid administration might save a patient's life, inadequate (or excessive) fluid use could lead to more complications, including organ failure and mortality due to either hypovolemia or volume overload. Currently, intensivists have access to a wide variety of information sources and tools to monitor the underlying hemodynamic status, including medical history, physical examination, and specific hemodynamic monitoring devices. Although appropriate and timely assessment and interpretation of this information can promote adequate fluid resuscitation, misinterpretation of these data can also lead to additional mortality and morbidity. This article provides a narrative review of the most commonly used hemodynamic monitoring approaches to assessing fluid responsiveness and fluid tolerance. In addition, we describe the benefits and disadvantages of these tools.
导致入住重症监护病房的主要原因之一是休克。确定休克的根本原因（低血容量性、分布性、心源性和阻塞性）可能会导致完全不同的管理临床路径。在低血容量性和分布性休克患者中，液体疗法是主要的治疗策略之一。尽管适当的液体输注量可能会挽救患者的生命，但液体使用不足（或过量）可能会导致更多的并发症，包括由于低血容量或容量超负荷导致的器官衰竭和死亡率。目前，重症监护医生可以使用各种信息来源和工具来监测潜在的血流动力学状态，包括病史、体格检查和特定的血流动力学监测设备。尽管对这些信息进行适当和及时的评估和解释可以促进充分的液体复苏，但对这些数据的错误解释也可能导致额外的死亡率和发病率。本文对评估液体反应性和液体耐受性最常用的血流动力学监测方法进行了叙述性综述。此外，我们还描述了这些工具的优缺点。
