The role for invasive monitoring in acute lung injury.
The role for invasive monitoring in acute lung injury.
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DOI：
10.1055/s-0033-1351127
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发表时间：
2013-08
影响因子：
3.2
通讯作者：
Martin GS
中科院分区：
文献类型：
--
作者：
Martin GS
由于急性肺损伤(ALI)可能是由各种不同的临床损伤引起的，因此对ALI患者的监测策略也是不同的。本综述将ALI的监测战略分为三个不同的阶段。“高危阶段”是指患者面临ALI风险的时期，可采用干预措施将这种风险降至最低或消除。“ALI期”是指ALI发生并需要细心临床治疗的时期。“消退阶段”是指ALI消退并成功停止机械通气的时间。这些阶段是任意的，但它们提供了一个有用的框架，用于讨论ALI患者病情和监测目标的时间变化。渗透式血流动力学监测在ALI患者治疗的每个阶段都有特定的作用：ALI前、ALI围手术期和ALI后。主要目标是优化液体复苏以预防器官功能障碍，包括ALI，如果出现额外的ALI，则应优化液体相对于肺的平衡。通过明智地应用有创血流动力学监测，特别是在其更现代的迭代，临床医生可以优化危重患者常见的潮起潮落阶段。鉴于我们目前对液体平衡与重要临床结果、多器官功能障碍综合征和死亡率之间的关系的了解日益加深，这一点至关重要。
Because acute lung injury (ALI) may arise from diverse and heterogeneous clinical insults, monitoring strategies for patients with ALI are heterogeneous as well. This review divides the monitoring strategies for ALI into three distinct phases. The “at-risk phase” is the period in which patients are at risk for ALI, and interventions may be applied to minimize or eliminate this risk. The “ALI phase” is the period during which ALI has occurred and requires attentive clinical management. The “resolution phase” is the period defined by resolution of ALI and successful discontinuation of mechanical ventilation. These phases are arbitrary, but they provide a useful framework for discussing the temporal changes in patient condition and monitoring goals in ALI.Invasive hemodynamic monitoring has specific roles in each phase of therapy for patients with ALI: pre-ALI, peri-ALI, and post-ALI. The primary goals are to optimize fluid resuscitation to prevent organ dysfunction, including ALI, and if ALI occurs to additional optimize fluid balance vis-à-vis the lung. By judicious application of invasive hemodynamic monitoring, particularly in its more modern iterations, clinicians can optimize the ebb and flow phases common to critically ill patients. This is vitally important given our current and growing understanding of the relationship between fluid balance and important clinical outcomes, multiple organ dysfunction syndrome, and mortality.
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影响因子：
168.9
作者：
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通讯作者：
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