Magder Sheldon
McGill University Health Centre, 1001 Decarie Blvd, H4A 3J1, Montreal, QC, Canada.
Ann Intensive Care. 2024 Jul 4;14(1):105. doi: 10.1186/s13613-024-01316-z.
Infusion of fluids is one of the most common medical acts when resuscitating critically ill patients. However, fluids most often are given without consideration of how fluid infusion can actually improve tissue perfusion. Arthur Guyton's analysis of the circulation was based on how cardiac output is determined by the interaction of the factors determining the return of blood to the heart, i.e. venous return, and the factors that determine the output from the heart, i.e. pump function. His theoretical approach can be used to understand what fluids can and cannot do. In his graphical analysis, right atrial pressure (RAP) is at the center of this interaction and thus indicates the status of these two functions. Accordingly, trends in RAP and cardiac output (or a surrogate of cardiac output) can provide important guides for the cause of a hemodynamic deterioration, the potential role of fluids, the limits of their use, and when the fluid is given, the response to therapeutic interventions. Use of the trends in these values provide a physiologically grounded approach to clinical fluid management.
在对重症患者进行复苏时，输液是最常见的医疗行为之一。然而，大多数情况下输液时并未考虑输液实际上如何改善组织灌注。亚瑟·盖顿对循环系统的分析基于心输出量是如何由决定血液回心的因素（即静脉回流）与决定心脏输出的因素（即泵功能）之间的相互作用所决定的。他的理论方法可用于理解液体能做什么和不能做什么。在他的图形分析中，右心房压力（RAP）处于这种相互作用的中心，因此表明这两种功能的状态。因此，RAP和心输出量（或心输出量的替代指标）的趋势可为血流动力学恶化的原因、液体的潜在作用、其使用限度以及输液时对治疗干预的反应提供重要指导。利用这些值的趋势为临床液体管理提供了一种基于生理学的方法。
