在重症监护中的流体管理:对最佳流体治疗的新见解
Nifa Sudheer1, Jeslin V James1
1Critical Care Medicine, Star Care Multispeciality Hospital, Kozhikode, IND.
Cureus
|January 10, 2025
概括
与盐水相比,平衡的晶类药物显著降低了急性损伤 (AKI) 和严重病患者的替代疗法 (RRT) 的需要. 使用平衡晶体质的液体限制也改善了ARDS,败血症和心力衰竭的结果.
科学领域:
- 关键护理医学 关键护理医学
- 腎臟病學 (nephrology) 是一種醫學.
- 重症监护病房 (ICU) 的管理人员.
背景情况:
- 有效的流体管理对于器官功能,脏完整性和重症患者的生存至关重要.
- 平衡的晶体化物在减轻急性损伤 (AKI) 和其他并发症方面比同位素盐水更有前途.
- 这项研究调查了平衡的晶体化物与AKI,脏替代疗法 (RRT) 和ICU中的死亡率的同位素盐水.
研究的目的:
- 为了比较ICU患者中平衡晶体化物与同位素盐水的临床结果.
- 评估对AKI,RRT和死亡率的影响.
- 评估液体限制在特定患者群体 (如ARDS,败血症和心力衰竭) 中的作用.
主要方法:
- 对600名成年ICU患者 (300个平衡晶体,300个同位素盐水) 的回顾性队列研究.
- 收集的数据包括AKI发生率,RRT,ICU死亡率,氧化,通风持续时间,液体平衡和ICU停留时间.
- 多变量逻辑回归用于统计分析,以控制混因子.
主要成果:
- 较低的AKI发病率 (12%对22%) 和RRT要求 (8%对15%) 与平衡的晶体化物 (p<0.05).
- 在ICU死亡率上没有统计学上显著的差异 (18%与24%,p=0.08).
- 使用平衡晶体的液体限制改善了ARDS,败血症和心力衰竭患者的氧化和减少了通风持续时间.
结论:
- 与同位素盐水相比,平衡的晶体质显著降低了AKI和RRT需求.
- 个性化流体管理,包括用平衡晶体进行流体限制,有利于特定的ICU人群.
- 支持偏好使用平衡晶体体,并建议进一步研究协议优化.
相关概念视频
Acute Respiratory Failure-V
123
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...
123
Parentral Nutrition: Centeral and Peripheral Parental Nutrition
98
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,...
98
Pneumonia V: Nursing management and Prevention
1.9K
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....
1.9K
Heart Failure Drugs: Diuretics
338
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...
338
Disorder of Water Balance
287
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...
287
Endoscopic Studies II: Thoracocentesis
199
Thoracentesis(Thoracocentesis), commonly known as pleural tap, is a medical procedure where a 22 gauge needle is inserted into the pleural space, the area between the lung and chest wall. This procedure is commonly performed to diagnose or treat various respiratory disorders.
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
199


