The Importance of Fluid Management in Acute Lung Injury Secondary to Septic Shock
The Importance of Fluid Management in Acute Lung Injury Secondary to Septic Shock
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DOI：
10.1378/chest.08-2706
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发表时间：
2009-07-01
期刊：
影响因子：
9.6
通讯作者：
Kollef, Marin H.
中科院分区：
文献类型：
--
作者：
Murphy, Claire V.;Schramm, Garrett E.;Kollef, Marin H.
背景资料：最近的研究表明，感染性休克患者的早期目标导向复苏和急性肺损伤（ALI）患者的保守液体管理可以改善预后。因为这些可能被视为潜在的冲突的做法，我们着手确定的影响，液体管理并发感染性休克患者的结果ALI.Methods：在巴恩斯犹太医院（圣路易斯，密苏里州）和医学ICU的马约医学中心（罗切斯特，明尼苏达州）进行了回顾性分析。因感染性休克住院的患者如果在感染性休克发作后72小时内符合美国-欧洲共识的ALI定义，则被纳入研究。充分的初始液体复苏（AIFR）定义为在血管加压药治疗开始前给予初始液体推注20 mL/kg，并在治疗开始后6 h内达到中心静脉压8 mm Hg。保守性晚期液体管理（CLFM）的定义是在感染性休克发病后的前7天内至少连续2天测量液体平衡为偶数至负值。在统计学上，同时达到AIFR和CLFM的患者的住院死亡率最低，而仅达到CLFM、仅达到AIFR和两者均未达到的患者的住院死亡率较高（93例患者中的17例[18.3%] vs 31例患者中的13例[41.9%] vs 53例患者中的30例[56.6%] vs 35例患者中的27例[77.1%]; p < 0.001）。感染性休克并发ALI的早期和晚期液体管理均可影响患者结局。（CHEST 2009; 136：102-109）
Background: Recent studies have suggested that early goal-directed resuscitation of patients with septic shock and conservative fluid management of patients with acute lung injury (ALI) can improve outcomes. Because these may be seen as potentially conflicting practices, we set out to determine the influence of fluid management on the outcomes of patients with septic shock complicated by ALI.Methods: A retrospective analysis was performed at Barnes-Jewish Hospital (St. Louis, MO) and in the medical ICU of Mayo Medical Center (Rochester, MN). Patients hospitalized with septic shock were enrolled into the study if they met the American-European Consensus definition of ALI within 72 h of septic shock onset. Adequate initial fluid resuscitation (AIFR) was defined as the administration of an initial fluid bolus of : 20 mL/kg prior to and achievement of a central venous pressure of 8 mm Hg within 6 h after the onset of therapy with vasopressors. Conservative late fluid management (CLFM) was defined as even-to-negative fluid balance measured on at least 2 consecutive days during the first 7 days after septic shock onset.Results: The study cohort was made up of 212 patients with ALI complicating septic shock. Hospital mortality was statistically lowest for those achieving both AIFR and CLFM and higher for those achieving only CLFM, those achieving only AIFR, and those achieving neither (17 of 93 patients [18.3%] vs 13 of 31 patients [41.9%] vs 30 of 53 patients [56.6%] vs 27 of 35 [77.1%], respectively; p < 0.001).Conclusions: Both early and late fluid management of septic shock complicated by ALI can influence patient outcomes. (CHEST 2009; 136:102-109)