Boldt J, Lenz M, Kumle B, Papsdorf M
Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Germany.
Intensive Care Med. 1998 Feb;24(2):147-51. doi: 10.1007/s001340050536.
To assess volume replacement strategies on intensive care units (ICUs) in Germany.
A postal survey questionnaire of 18 questions was sent to 451 ICUs in Germany. The questionnaire was sent to general, surgical, anesthesiology, neurosurgery, cardiac surgery, and medical ICUs of hospital with more than 200 beds.
286 questionnaires (64%) were returned and analysed. Hydroxyethylstarch (HES) solution is the solution most often used for volume replacement (total: 193 ICUs, exclusively HES: 93 ICUs), crystalloids are next (crystalloids exclusively: 61 ICUs), and human albumin is used rarely as a first choice. Clinical experience is a very important argument for administering volume. Diagnostic tools, e.g. measurement of central venous pressure or pulmonary capillary wedge pressure, also play an important role. Albumin/total protein and colloid osmotic pressure (COP) are measured often on ICUs (albumin measured routinely: 173 ICUs; COP measured routinely: 33 ICUs). Critical values for albumin/total protein are defined in most ICUs. Reduced plasma levels of albumin/total protein was the indication most often cited for administering human albumin. Only 149 ICUs (52%) have a financial budget for their unit. Costs still do not play a major role in the choice of volume replacement on 30 ICUs (10%).
The kind of volume therapy differs widely among the different ICUs. This questionnaire supported the supposition that no standards exist for volume therapy in intensive care patients. New results concerning the abuse of albumin in the critically ill have not yet influenced strategies of volume replacement.
评估德国重症监护病房（ICU）的容量替代策略。
向德国451个ICU发送了一份包含18个问题的邮政调查问卷。问卷发送至拥有200张以上床位医院的综合、外科、麻醉、神经外科、心脏外科和内科ICU。
共收回并分析了286份问卷（64%）。羟乙基淀粉（HES）溶液是最常用于容量替代的溶液（总计：193个ICU，仅使用HES：93个ICU），其次是晶体液（仅使用晶体液：61个ICU），人白蛋白很少作为首选使用。临床经验是进行容量治疗的一个非常重要的依据。诊断工具，如中心静脉压或肺毛细血管楔压的测量，也起着重要作用。白蛋白/总蛋白和胶体渗透压（COP）在ICU中经常被测量（常规测量白蛋白：173个ICU；常规测量COP：33个ICU）。大多数ICU都定义了白蛋白/总蛋白的临界值。白蛋白/总蛋白血浆水平降低是最常被引用的使用人白蛋白的指征。只有149个ICU（52%）有本单位的财务预算。成本在30个ICU（10%）的容量替代选择中仍未起主要作用。
不同ICU之间的容量治疗种类差异很大。这份调查问卷支持了重症监护患者容量治疗不存在标准的假设。关于危重病患者滥用白蛋白的新结果尚未影响容量替代策略。
