Understanding and managing fluid balance in patients with acute lung injury.
Understanding and managing fluid balance in patients with acute lung injury.
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DOI：
10.1097/00075198-200402000-00003
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发表时间：
2004-02-01
影响因子：
3.3
通讯作者：
Martin, Greg S
中科院分区：
文献类型：
--
作者：
Lewis, Charmaine A;Martin, Greg S
回顾目的：急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）每年影响全球数十万人，造成重大的医疗负担。在过去的四十年里，关于肺损伤的病理生理学已经被发现了很多，但在推进有效的治疗策略方面却没有取得什么进展。在这篇文章中，我们讨论了目前关于ALI/ARDS病理生理学中流体平衡的知识，以及最近在这种情况下与流体静压或致瘤压力操作相关的创新。最近发现：低蛋白血症是ALI/ARDS的明确标志，鉴于其独立的预后价值，可能发挥病理生理作用。利尿剂和胶体治疗引起的体液平衡和肿瘤压力改变可改善呼吸生理，并可能改变损伤毛细血管-肺泡膜上的液体净通量。胸片可作为监测急性呼吸窘迫综合征/ARDS患者纵向体液平衡操作的有用辅助工具。摘要：在已确诊的ALI/ARDS患者中，操纵欧椋鸟力可产生显著的生理益处，并可能影响预后。未来的研究应侧重于确定这种现成的干预措施对死亡率的益处。
PURPOSE OF REVIEW: Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) affect hundreds of thousands of people each year worldwide, resulting in a significant healthcare burden. Over the past four decades, much has been discovered regarding the pathophysiology of lung injury, yet little progress has been made in advancing effective treatment strategies. In this article, we discuss the current knowledge as to fluid balance in the pathophysiology of ALI/ARDS and the recent innovations that have been described related to manipulations of hydrostatic or oncotic pressure in this condition.RECENT FINDINGS: Hypoproteinemia is a clear marker for ALI/ARDS and may play a pathophysiologic role given its independent prognostic value. Fluid balance and oncotic pressure alterations induced by diuretic and colloid therapy improve respiratory physiology and likely alter net flux of fluid across the injured capillary-alveolar membrane. Chest radiographs serve as a useful adjunctive tool in monitoring longitudinal fluid balance manipulations in ALI/ARDS.SUMMARY: Manipulation of Starling forces in established ALI/ARDS produces significant physiologic benefit and may influence outcome. Future research should focus on determining a mortality benefit with this readily available intervention.