Burden of psychological symptoms and illness in family of critically ill patients: what is the relevance for critical care clinicians?
Burden of psychological symptoms and illness in family of critically ill patients: what is the relevance for critical care clinicians?
复制标题
重症患者家属的心理症状和疾病负担：对重症监护临床医生有何意义？
DOI：
10.1097/ccm.0b013e31817616c0
复制
发表时间：
2008
影响因子：
8.8
通讯作者：
Curtis,JRandall
中科院分区：
文献类型：
--
作者：
Kross,ErinK;Curtis,JRandall
重症监护室（ICU）和急诊科的护理人员熟悉脓毒症的血流动力学异常及其适当的治疗。关键是早期识别，如果需要的话，用液体和血管加压剂复苏，并治疗潜在的原因。这种方法是败血症生存运动（1）血流动力学管理指南以及该运动6小时复苏护理包的基础。然而，这一共识隐藏了困扰我们改善护理能力的根本困难，特别是对于那些在初始复苏后无法稳定或逆转休克并需要更先进和更长时间支持的患者。一旦进入第二阶段，关于最合适的血流动力学监测技术、正确的治疗目标和终点，甚至是给予何种液体和血管活性药物的协议就消失了。国际上的实践各不相同，在美国倾向于晶体复苏，在欧洲更多地使用人工胶体，尽管最近的大型研究结果（2，3）意味着这些模式处于不断变化的状态。用于指导治疗的血流动力学监测也存在差异，因此护理模式也存在差异。一般而言，在美国更依赖充盈压力，而在欧洲更依赖“混合经济”，更广泛地采用各种流量和容积测量技术（经尿道热稀释法、动脉脉搏波分析、食管多普勒）。人们普遍同意使用音量挑战和展示音量响应的重要性，但不太清楚这样做的最佳方式。实践中的这种变化可能是由于我们对脓毒症病理生理学的基本理解仍然存在差距，因为准确描述ICU中的复杂生理学仍然是一个挑战。正是在这种具有挑战性的背景下，Viellard-Baron博士和他的同事（4）在本期杂志上发表了他们关于感染性休克中左心室运动功能减退发生率的有趣研究。
The hemodynamic abnormali-ties of sepsis, and their appropriate treatment, are familiar to caregivers in the intensive care unit (ICU) and the emergency department. The key is early recognition, resuscitation with fluids and vasopressors if required, and treatment of the underlying cause. This approach is the basis of the hemodynamic management guidelines of the Surviving Sepsis Campaign (1), and of the campaign’s 6-hr resuscitation care bundle. Yet, this consensus hides fundamental difficulties that bedevil our ability to improve care, especially for patients who do not stabilize or reverse their shock after initial resuscitation and require more advanced and prolonged support. Once into this second phase, agreement disappears as to the most appropriate hemodynamic monitoring techniques, the correct targets and end points of treatment, and even which fluids and vasoactive drugs to give. Practice varies internationally, with a preference for crystalloid resuscitation in the United States, and greater use of artificial colloids in Europe, although the results of recent large studies (2, 3) mean that these patterns are in a state of flux. There are also differences in the hemodynamic monitoring used to guide therapy, and therefore the paradigms of care. In general terms, there is a greater reliance on filling pressures in the United States, and a more “mixed economy” in Europe, with various flow and volume measurement techniques (transpulmonary thermodilution, arterial pulse wave analysis, esophageal Doppler) more widely employed. There is general agreement about the importance of using volume challenges and demonstrating volume responsiveness, but less clarity about the best way of doing this. This variation in practice possibly is due to the gaps that still exist in our fundamental understanding of the pathophysiology of sepsis, because accurate description of complex physiology in the ICU remains a challenge. It is against this challenging background that Dr. Viellard-Baron and colleagues (4) publish their intriguing study of the incidence of left ventricular hypokinesia in septic shock in this issue of
登录
查看更多内容
影响因子：
39.2
作者：
Kroenke, Kurt;Spitzer, Robert L.;Lowe, Bernd
通讯作者：
Lowe, Bernd
影响因子：
8.8
作者：
Pochard, F;Azoulay, E;Schlemmer, B
通讯作者：
Schlemmer, B
DOI：
10.1164/rccm.200409-1295oc
发表时间：
2005-05-01
影响因子：
24.7
作者：
Azoulay, E;Pochard, F;Schlemmer, B
通讯作者：
Schlemmer, B
关于维持生命治疗的决定。
影响因子：
--
作者：
V. Tilden;S. Tolle;M. Garland;C. C. Nelson
通讯作者：
C. C. Nelson