在患有败血症和ARDS的患者中,以体积参数为指导优化流体管理
Evgeniia V Fot1, Natalia O Khromacheva1, Aleksei A Ushakov1
1Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk 163000, Russia.
使用外血管肺水 (EVLWI) 或全球末端透析体积 (GEDVI) 的液体缓解策略改善了败血症和ARDS的结果. 以EVLWI为指导的治疗显示了氧化和肺液平衡的更大改善.
科学领域:
- 关键护理医学 关键护理医学
- 肺部医学 肺部医学
- 紧急医疗 紧急医疗
背景情况:
- 败血症和急性呼吸困扰综合征 (ARDS) 是危急的情况,通常需要流体管理.
- 优化流体治疗对于败血症诱导的ARDS患者的结果至关重要.
- 液体治疗的缓解旨在减少液体过载并改善呼吸机制.
研究的目的:
- 为了比较两种减缓流体治疗的流体治疗策略,在败血症和ARDS患者.
- 为了评估外血管肺水指数 (EVLWI) 与全球终端透气体积指数 (GEDVI) 导向降级的疗效.
- 评估对氧化,肺液平衡和器官功能障碍的影响.
主要方法:
- 一项随机对照试验,涉及60名败血症和ARDS患者.
- 患者被分配到由EVLWI (n=30) 或GEDVI (n=30) 指导的液体降级.
- 当GEDVI>650mL/m2或EVLWI>10mL/kg时,使用利尿剂或超过来达到负流体平衡.
主要成果:
- 这两种策略都导致SOFA评分下降,并改善了动脉氧化 (PaO2 / FiO2).
- 以EVLWI为指导的治疗显著减少了血管外肺水,并显示了PaO2 / FiO2 (30%与15%相比) 的较大增加.
- 患有直接ARDS的患者对脱水治疗对氧化和肺液平衡的反应更好.
结论:
- 以EVLWI和GEDVI为指导的降级策略都有效地改善了败血症引起的ARDS的结果.
- 在减少肺液和改善氧化方面,EVLWI引导的降级似乎更有效,特别是在直接的ARDS中.
- 缓解升级疗法对管理体液平衡和在败血症和ARDS中器官功能障碍有好处.
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