Domi Rudin, Coniglione Filadelfo, Huti Gentian, Lilaj Krenar
Department of Surgery, Faculty of Medicine, University of Medicine, Tirana, Albania.
Department of Clinical Science and Translational Medicine, University of Rome, Tor Vergata School of Medicine and Surgery, Rome, Italy.
Anesth Pain Med (Seoul). 2025 Jan 15;20(2):127-35. doi: 10.17085/apm.24103.
Permissive strategies in the intensive care unit (PSICU) intentionally allow certain physiological parameters to deviate from traditionally strict control limits to mitigate the risks associated with overly aggressive interventions. These strategies have emerged in response to evidence that rigid adherence to normal physiological ranges may cause harm to critically ill patients, leading to iatrogenic complications or exacerbation of underlying conditions. This review discusses several permissive strategies, including those related to hypotension, hypercapnia, hypoxemia, and lower urinary output thresholds. The key principles of these strategies require careful balancing and close monitoring to ensure that the benefits outweigh the risks for each patient. This approach emphasizes individualized care, thoughtful decision-making, and flexible application of guidelines. The use of a PSICU may help minimize the side effects of treatment while addressing the primary condition of the patient and allowing for a more holistic view of critically ill patients.
重症监护病房的宽松策略（PSICU）有意让某些生理参数偏离传统上严格的控制限度，以降低与过度积极干预相关的风险。这些策略的出现是因为有证据表明，严格遵循正常生理范围可能会对重症患者造成伤害，导致医源性并发症或使基础病情恶化。本综述讨论了几种宽松策略，包括与低血压、高碳酸血症、低氧血症和较低尿量阈值相关的策略。这些策略的关键原则需要仔细权衡并密切监测，以确保对每位患者而言益处大于风险。这种方法强调个性化护理、深思熟虑的决策制定以及指南的灵活应用。采用PSICU可能有助于在治疗患者主要病症的同时将治疗副作用降至最低，并能对重症患者有更全面的认识。
