Hemodynamic monitoring in shock and implications for management International Consensus Conference, Paris, France, 27-28 April 2006
Hemodynamic monitoring in shock and implications for management International Consensus Conference, Paris, France, 27-28 April 2006
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DOI：
10.1007/s00134-007-0531-4
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发表时间：
2007-04-01
影响因子：
38.9
通讯作者：
Torres, Antoni
中科院分区：
文献类型：
--
作者：
Antonelli, Massimo;Levy, Mitchell;Torres, Antoni
目的：休克是一种严重的多器官功能障碍综合征，死亡率高。本共识声明的目的是为危重休克患者的监测和管理提供建议。方法：2006年4月召开了一次国际共识会议，以制定休克患者血流动力学监测和管理的建议。在与专家协商并审查相关文献后，由代表五个重症监护学会的11人组成的陪审团制定了基于证据的建议。数据综合：共制定了17项建议，为重症监护医生监测和护理休克患者提供指导。讨论的主题如下：(1)ICU休克的流行病学和病理生理特征是什么？(2)休克时是否应监测预负荷和液体反应？(3)休克时如何及何时监测脑卒中量或心输出量？(4)局部和微循环的哪些标志物可以监测，如何评估休克时的细胞功能？(5)使用血流动力学监测指导休克治疗的证据是什么？最重要的建议之一是，不需要低血压来定义休克，因此，在体格检查中，组织灌注不足的存在是很重要的。根据目前的证据，唯一推荐用于休克诊断或分期的生物标志物是血乳酸。陪审团还建议不要常规使用(1)休克时肺动脉导管和(2)单独使用静态预负荷测量来预测液体反应。结论：这一共识声明提供了17种不同的建议，涉及到休克患者的监测和护理。有一些重要问题无法通过循证方法得到充分解决，并确定了需要进一步研究的领域。
Objective: Shock is a severe syndrome resulting in multiple organ dysfunction and a high mortality rate. The goal of this consensus statement is to provide recommendations regarding the monitoring and management of the critically ill patient with shock. Methods: An international consensus conference was held in April 2006 to develop recommendations for hemodynamic monitoring and implications for management of patients with shock. Evidence-based recommendations were developed, after conferring with experts and reviewing the pertinent literature, by a jury of 11 persons representing five critical care societies. Data synthesis: A total of 17 recommendations were developed to provide guidance to intensive care physicians monitoring and caring for the patient with shock. Topics addressed were as follows: (1) What are the epidemiologic and pathophysiologic features of shock in the ICU? (2) Should we monitor preload and fluid responsiveness in shock? (3) How and when should we monitor stroke volume or cardiac output in shock? (4) What markers of the regional and micro-circulation can be monitored, and how can cellular function be assessed in shock? (5) What is the evidence for using hemodynamic monitoring to direct therapy in shock? One of the most important recommendations was that hypotension is not required to define shock, and as a result, importance is assigned to the presence of inadequate tissue perfusion on physical examination. Given the current evidence, the only biomarker recommended for diagnosis or staging of shock is blood lactate. The jury also recommended against the routine use of (1) the pulmonary artery catheter in shock and (2) static preload measurements used alone to predict fluid responsiveness. Conclusions: This consensus statement provides 17 different recommendations pertaining to the monitoring and caring of patients with shock. There were some important questions that could not be fully addressed using an evidence-based approach, and areas needing further research were identified.