From the Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital Paul-Brousse, Paris, France.
Outcomes Research Consortium, Cleveland, Ohio.
Anesth Analg. 2024 Feb 1;138(2):284-294. doi: 10.1213/ANE.0000000000006672. Epub 2024 Jan 12.
Intravenous (IV) fluids and vasopressor agents are key components of hemodynamic management. Since their introduction, their use in the perioperative setting has continued to evolve, and we are now on the brink of automated administration. IV fluid therapy was first described in Scotland during the 1832 cholera epidemic, when pioneers in medicine saved critically ill patients dying from hypovolemic shock. However, widespread use of IV fluids only began in the 20th century. Epinephrine was discovered and purified in the United States at the end of the 19th century, but its short half-life limited its implementation into patient care. Advances in venous access, including the introduction of the central venous catheter, and the ability to administer continuous infusions of fluids and vasopressors rather than just boluses, facilitated the use of fluids and adrenergic agents. With the advent of advanced hemodynamic monitoring, most notably the pulmonary artery catheter, the role of fluids and vasopressors in the maintenance of tissue oxygenation through adequate cardiac output and perfusion pressure became more clearly established, and hemodynamic goals could be established to better titrate fluid and vasopressor therapy. Less invasive hemodynamic monitoring techniques, using echography, pulse contour analysis, and heart-lung interactions, have facilitated hemodynamic monitoring at the bedside. Most recently, advances have been made in closed-loop fluid and vasopressor therapy, which apply computer assistance to interpret hemodynamic variables and therapy. Development and increased use of artificial intelligence will likely represent a major step toward fully automated hemodynamic management in the perioperative environment in the near future. In this narrative review, we discuss the key events in experimental medicine that have led to the current status of fluid and vasopressor therapies and describe the potential benefits that future automation has to offer.
静脉（IV）液体和血管加压剂是血流动力学管理的关键组成部分。自引入以来，它们在围手术期的使用不断发展，我们现在正处于自动化管理的边缘。静脉补液疗法于 1832 年在苏格兰霍乱流行期间首次被描述，当时医学先驱拯救了因低血容量性休克而生命垂危的重症患者。然而，广泛使用静脉补液仅始于 20 世纪。肾上腺素于 19 世纪末在美国被发现并纯化，但由于半衰期短，其在患者治疗中的应用受到限制。静脉通路的进步，包括中心静脉导管的引入，以及能够连续输注液体和血管加压剂而不仅仅是推注，促进了液体和肾上腺素类药物的使用。随着先进血流动力学监测技术的出现，尤其是肺动脉导管，通过足够的心输出量和灌注压维持组织氧合的液体和血管加压剂的作用变得更加明确，并且可以设定血流动力学目标以更好地调整液体和血管加压剂治疗。使用超声心动图、脉搏轮廓分析和心肺相互作用等较少侵入性血流动力学监测技术，使床旁血流动力学监测变得更加容易。最近，在闭环液体和血管加压剂治疗方面取得了进展，该技术应用计算机辅助来解释血流动力学变量和治疗。人工智能的发展和应用可能代表着在不久的将来在围手术期环境中实现完全自动化血流动力学管理的重要一步。在本叙述性综述中，我们讨论了导致目前液体和血管加压剂治疗现状的实验医学中的关键事件，并描述了未来自动化带来的潜在益处。
