危急病患者的液体摄入量:多中心前性队列研究"储存无用的液体进行密集复苏"
Frédérique Schortgen1, Cécilia Tabra Osorio1, Dorothée Carpentier2
1Réanimation et surveillance continue adulte, Centre hospitalier intercommunal, Créteil, France.
Critical care medicine
|November 1, 2023
概括
在重症监护室 (ICU) 优化液体摄入至关重要. 这项研究发现,对体液平衡至关重要的液体是总摄入量的少数部分,在ICU之间存在显著的差异.
科学领域:
- 关键护理医学 关键护理医学
- 流体管理流体管理
- 重症监护室 (ICU) 的实践
背景情况:
- 积极的液体平衡对ICU患者构成风险,需要优化液体摄入量.
- 非复苏液体的使用往往受到较少的关注.
- 了解初始液体摄入的异质性是患者管理的关键.
研究的目的:
- 为了评估在重症监护病房的复苏的初始阶段的液体摄入的异质性.
- 为了确定影响流体输送量和类型的因素.
主要方法:
- 未来的多中心队列研究涉及法国的30个ICU和西班牙的1个.
- 包括需要血管压缩剂和/或侵入性机械通风的患者.
- 在入院后24小时内,记录和分类所有血管和肠道液体的管理.
主要成果:
- 平均总液体体积为3546毫升;平衡目标液体仅占36%.
- 盐水,高化物晶体化物和平衡晶体化物分别占总体量的43%,27%和16%.
- 包容中心是液体体积的最强的预测因素,比患者的特征更强.
结论:
- 对于体液平衡来说,必需的液体是初始ICU液体摄入量的少数部分.
- 在ICU之间存在流体管理实践的显著异质性,由中心效应驱动.
- 需要制定最佳的流体体积策略和流体的目标在普通流体的管理是必要的.
相关概念视频
Acute Kidney Injury V: Interprofessional Care
11
Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
11
Acute Kidney Injury VI: Nursing Management
13
Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
13
Acute Kidney Injury IV: Diagnostic Studies and Prevention
18
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
18
Regulation of Water Intake
530
Osmolality refers to the number of solute particles per kilogram of solvent in a solution. Plasma osmolality specifically indicates the total number of solute particles per kilogram of water in blood plasma. This value reflects the body's hydration status and is tightly regulated through mechanisms controlling water intake and output. While water consumption is a conscious decision, the body has intrinsic regulatory systems to maintain fluid balance. Dehydration, a state of water deficit...
530
Heart Failure VI: Adjunct Therapies
15
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
15
Chronic Kidney Disease IV: Nursing Management
9
Nursing management is essential for preventing complications, maintaining stability, and improving patients' quality of life in chronic kidney disease (CKD). By using a structured approach, nurses help slow CKD progression and support effective patient care.1. Comprehensive patient assessmentEffective management begins with nurses reviewing the patient’s medical history, and identifying key risk factors like diabetes, hypertension, and nephrotoxic drug use. Nurses assess signs of...
9


