セプシス を 患う 重症 な 大人 の ため の 流体 療法: レビュー
Fernando G Zampieri1, Sean M Bagshaw1, Matthew W Semler2,3
1Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada.
JAMA
|June 14, 2023
まとめ
流体療法はセプシス患者にとって不可欠ですが,目標指向療法や血管圧縮剤の使用などの特定の戦略は試験で死亡率を低下させませんでした. 液体摂取を制限し,利尿剤を使用すると,いくつかの症例で改善されました.
科学分野:
- クリティカルケア医療
- 腎臓科
- 心臓病科
背景:
- セプシスはICU患者の20~30%に及ぶ.
- 静脈内注射液はセプシスの治療に不可欠です.
- 液体療法には 異なる段階があります 蘇生,最適化,安定化,避難です
研究 の 目的:
- セプシス患者の死亡率とアウトカムに対する異なる液体投与戦略の影響を評価する.
- 様々なセプシス段階における目標指向療法,血管圧縮薬,および液体制限の有効性を分析する.
主な方法:
- セプシス患者のランダム化臨床試験 (RCT) のレビュー
- 低血圧患者1563人,セプティックショック患者1554人からのデータを分析した.
- 避難段階における急性呼吸困難を患った1000人の患者のRCTの評価.
主要な成果:
- 非構造的治療 (24. 9% 対 25. 4%) と比較すると,目標指向治療は死亡率を低下させなかった.
- 血管圧縮薬による治療は,低血圧の死亡率と液体投与の死亡率を改善しなかった (14. 0% vs 14. 9%).
- セプティックショックにおける水分制限は死亡率を低下させなかった (42. 3% 対 42. 1%).
- ARDSでは,水分を制限し,利尿剤を使用することで,呼吸器なしで過ごす日数が改善されました (14. 6 vs 12. 1日).
- 水素エチル粉は,塩水またはリンガー溶液と比較して腎臓置換治療の発生率を増加させた.
結論:
- セプシスの最適な流体管理は不明である.
- 臨床医は各段階において 液体のリスクと利益を考慮する必要があります
- ハイドロキシエチル粉は避けるべきであり,ARDSの回復では液体除去を考慮する.
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