在重症监护病房实施和评估基于体重的血管压缩剂
Laurie DeMillard1, Michael Thuyns1
1Department of Pharmacy, Renown Regional Medical Center, Reno, NV, USA.
概括
基于体重 (WB) 的血管压缩剂剂量策略与非基于体重 (NWB) 的方法在达到重症患者的目标平均动脉压 (MAP) 方面没有显著差异. 这两种方法都被证明同样有效,这表明机构战略的一致性是关键.
科学领域:
- 关键护理医学 关键护理医学
- 药理学 药理学是指药理学的学科.
- 临床治疗学 临床治疗学
背景情况:
- 血管压缩剂,如诺拉上腺素,对于维持重症患者的平均动脉压 (MAP) 至关重要.
- 最佳的血管压缩剂剂量策略仍未得到充分研究,影响了患者的护理.
- 目前的做法往往缺乏基于体重 (WB) 或非基于体重 (NWB) 的标准化剂量协议.
研究的目的:
- 为了比较基于体重 (WB) 的理想体重与非基于体重 (NWB) 的血管压缩剂剂量策略的疗效.
- 评估不同剂量策略对在重症监护室 (ICU) 患者中实现目标MAP的影响.
- 为了确定与血管压缩剂的管理相关的二次结果的潜在差异.
主要方法:
- 对接受血管压缩剂≥4小时的ICU患者的回顾性图表审查.
- 用NWB与WB血管压缩剂剂量管理的患者的比较.
- 主要终点:实现目标MAP的时间;次要终点:血管活性剂的使用,住院时间,通风持续时间.
主要成果:
- 在NWB (24分钟) 和WB (21分钟) 组之间实现目标MAP的中位时间没有显著差异 (P=0.1713).
- 二次结果,包括住院时间和通风持续时间,没有显著差异.
- 在败血症休克患者的亚组分析表明,WB组的皮质类固醇使用率较高 (54%对14%).
结论:
- 基于体重 (WB) 和非基于体重 (NWB) 的血管压缩剂剂量策略在实现目标MAP方面表现出可比的有效性.
- 在关键的二次临床结果中没有发现显著差异.
- 机构应采用一致的血管压缩剂剂量策略,无论是WB还是NWB,以改善护理标准化.
相关概念视频
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
431
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
431
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
565
Accurate blood pressure assessment is crucial for diagnosing and managing various health conditions. To ensure the reliability of these measurements, healthcare professionals must adhere to standardized pre-procedural guidelines. These guidelines enhance patient safety and improve the overall quality of healthcare. The following steps are essential for obtaining accurate and consistent blood pressure readings, from using the appropriate tools to ensuring effective communication with the...
565
01:22Heart Failure Drugs: Diuretics
381
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
381
01:30Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors
645
Angiotensin-converting enzyme (ACE), a vital component of the renin-angiotensin-aldosterone system, is abundant in lung endothelial cells. ACE converts the inactive decapeptide, angiotensin I, into the active octapeptide, angiotensin II. This potent vasoconstrictor narrows blood vessels, increasing resistance to blood flow and elevating blood pressure. Angiotensin II also stimulates aldosterone production, encouraging kidney cells to reabsorb more sodium and water from urine, thereby increasing...
645
01:22Heart Failure Drugs: β-Blockers
340
β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
340