严重患有败血症的成年人接受液体治疗:一篇评论
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
概括
流体治疗对于败血症患者至关重要,但针对性治疗或血管压缩剂使用等特定策略在试验中没有降低死亡率. 在某些情况下,限制饮用液体和使用利尿剂改善了结果.
科学领域:
- 危急护理医学
- 肝脏病学
- 心脏病学
背景情况:
- 败血症影响到20-30%的ICU患者.
- 静脉注射液体对于治疗败血症至关重要.
- 流体治疗有不同的阶段:复苏,优化,稳定和疏散.
研究的目的:
- 评估不同流体施用策略对败血症患者的死亡率和结果的影响.
- 分析目标导向治疗,血管压缩剂和各种败血症阶段的液体限制的有效性.
主要方法:
- 参与败血症患者的随机临床试验 (RCT) 的审查.
- 分析了3723名接受1-2升液体,1563名低血压和1554名败血症患者的数据.
- 在疏散阶段对1000名急性呼吸困难患者进行RCT的评估.
主要成果:
- 与非结构化治疗相比,以目标为导向的治疗没有降低死亡率 (24. 9% vs 25. 4%).
- 血管压缩剂治疗没有改善死亡率,而液体治疗则降低了血压 (14. 0% vs 14. 9%).
- 在败血症休克中限制流体并没有降低死亡率 (42. 3% 与42. 1% 相比).
- 在ARDS中,限制饮用液体和使用利尿剂改善了无呼吸器的日子 (14. 6 vs 12. 1天).
- 与盐水或林格溶液相比,基粉增加了置换治疗的发生率.
结论:
- 在败血症的最佳流体管理仍然不确定.
- 临床医生应在每个阶段权衡液体的风险和益处.
- 避免使用基乙醇粉,并考虑在ARDS恢复过程中去除液体.
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