对于在医院的成年人进行维护性液体治疗,NICE指南是否适合?
Robert G Hahn1, Niels Van Regenmortel2
1Karolinska Institutet at Danderyds Hospital (KIDS), Stockholm, Sweden.
Clinical nutrition ESPEN
|June 29, 2024
概括
国家卫生和护理卓越研究所 (NICE) 关于维持液体治疗的指导方针提供了不足的水和,可能导致脱水. 这项研究发现,目前的建议对于维持成年人必需液体平衡是不够的.
科学领域:
- 医学科学 医学科学 医学科学
- 身体生理学 身体生理学
- 临床研究 临床研究
背景情况:
- 美国国家卫生与护理卓越研究所 (NICE) 对成年人维持液体治疗的指导方针被广泛采用,但缺乏严格的评估.
- 目前的NICE建议每天摄入液体 (25-30毫升/公斤/天) 和电解质 (1毫摩尔/公斤的和) 需要评估是否足够.
- 这项研究解决了评估NICE维护液体治疗指南对人类生理要求的充分性的需要.
研究的目的:
- 调查NICE指南推的液体和电解质摄入量是否足以满足成年人的需求.
- 评估维护液中的不同度对细胞外流体体积 (ECV) 和细胞内流体体积 (ICV) 的影响.
- 在大量志愿者和患者中确定典型的水摄入量和电解质分泌水平.
主要方法:
- 一个交叉输液实验,12名志愿者每天接受25毫升/千克的高 (154毫摩尔/升) 或低 (54毫摩尔/升) 溶液,持续48小时,以测量液体分布.
- 分析了来自719名志愿者和患者的尿样,以量化脏水的保存和/分泌量.
- 一项饮食研究的回顾性分析,以估计研究人口中历史的液体摄入量和电解质分泌模式.
主要成果:
- 高液维持了ECV,但在48小时后导致ICV下降1.3升.
- 低含量液体导致1.7升的总体积赤字,同样影响ECV和ICV.
- 估计每天平均摄入水量为2.6L,平均排泄量为2 mmol/kg的和1 mmol/kg的.
结论:
- 根据NICE指南推的水和摄入量不足以充分维持ECV和ICV.
- 当前的维持液体治疗建议可能会导致有害的液体和电解质失衡.
- 根据这些发现,重新评估NICE关于维持液体治疗的指南是有必要的.
相关概念视频
Parentral Nutrition: Centeral and Peripheral Parental Nutrition
124
Parenteral Nutrition (PN) delivers essential nutrients directly into the bloodstream, bypassing the digestive system. It is commonly used for individuals with severe digestive disorders or conditions that prevent normal nutrient absorption.
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
124
Pneumonia V: Nursing management and Prevention
2.0K
Nursing management of pneumonia involves promoting airway patency, facilitating rest and conserving energy, encouraging fluid intake, maintaining nutrition, and educating patients.
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
2.0K
Acute Respiratory Failure-V
130
The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...
130
Pneumonia IV: Management
318
The treatment of pneumonia varies based on its severity and the causative pathogen. Here is a structured approach to managing pneumonia, integrating pharmaceutical and supportive care strategies.
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
318
Disorder of Water Balance
349
Water balance disorders are medical conditions that occur when there is a deviation from the body's water volume or osmolarity, disrupting normal homeostasis and leading todehydration, hypotonic hydration, hyperhydration, edema, or water intoxication.
Dehydration
Dehydration occurs when the body loses fluids (particularly water).
Causes:
The major causes of dehydration include excessive sweating, fever, vomiting, diarrhea, and diuresis.
Signs and Symptoms:
Symptoms primarily include intense...
Dehydration
Dehydration occurs when the body loses fluids (particularly water).
Causes:
The major causes of dehydration include excessive sweating, fever, vomiting, diarrhea, and diuresis.
Signs and Symptoms:
Symptoms primarily include intense...
349
Heart Failure Drugs: Diuretics
362
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...
362


