Inflammation and the host response to injury, a large-scale collaborative project: Patient-oriented research core - Standard operating procedures for clinical care III. Guidelines for shock resuscitation
Inflammation and the host response to injury, a large-scale collaborative project: Patient-oriented research core - Standard operating procedures for clinical care III. Guidelines for shock resuscitation
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DOI：
10.1097/01.ta.0000225933.08478.65
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发表时间：
2006-07-01
影响因子：
--
通讯作者：
Maier, Ronald V.
中科院分区：
文献类型：
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作者：
Moore, Frederick A.;McKinley, Bruce A.;Maier, Ronald V.
严重创伤常伴有休克。除了急性死亡外，休克是多器官功能障碍综合征（MODS）的主要危险因素，休克复苏是强制性的早期干预。由于复苏不足和过度复苏都有助于MODS的发病机制，因此可以通过制定指南来确保早期一致和适当的复苏努力，将MODS发展的可能性降到最低。本指南的挑战包括：a)早期识别高风险患者，b)在监测复苏的次优环境中实施，c)早期识别需要更积极干预的复苏“无反应者”，以及d)避免可能有害的过度干预。本指南基于现有的最佳证据和专家共识讨论，得到了美国国家普通医学科学研究所炎症和宿主对损伤的大规模合作项目奖的支持，并正在资助的临床研究中使用。1,2以下部分简要概述了具体指南建议的基本原理。接下来是两种算法，描述了对持续容量负荷和/或输血无反应的患者亚群中干预措施和监测要求的升级。随着多机构的经验和批判性分析，这种复苏过程可能会进一步完善；目前，它的目的是作为干预性试验的模板，并测试新的监测技术的效用。该方案是为钝性创伤患者设计的，他们被认为没有严重的伴发脑损伤。其目的是指导在到达急诊科（ED）后，在控制活动性躯干出血后尽快进行复苏。
Shock frequently accompanies severe trauma. In addition to acute mortality, shock is a predominant risk factor for multiple organ dysfunction syndrome (MODS) and shock resuscitation is an obligatory early intervention. Because both under and over resuscitation contribute to the pathogenesis of MODS, the potential for MODS development can be minimized by developing a guideline to insure early consistent and appropriate resuscitative efforts. The challenges of this guideline include: a) early identification of high risk patients, b) implementation in environments that are suboptimal for monitoring resuscitation, c) early identification of resuscitation “non-responders” that require more aggressive interventions, and d) avoiding potentially harmful over zealous interventions.This guideline is based on the best available evidence and expert consensus discussions supported by the Inflammation and Host Response to Injury Large Scale Collaborative Project award from the National Institute of General Medical Sciences, and is being used in the funded clinical studies. 1, 2 The following section provides a brief overview of the rationale for specific guideline recommendations. This is followed by two algorithms that depict escalation in interventions and monitoring requirements in the subset of patients who do not respond to ongoing volume loading and/or blood transfusions. With multi institutional experience and critical analysis this resuscitation process may be further refined; at this time it is intended to serve as a template for interventional trials and to test the utility of new monitoring technology. This protocol was designed for blunt trauma patients who are presumed not to have a serious concomitant brain injury. Its purpose is to guide resuscitation as soon as feasible after arrival in the Emergency Department (ED) after control of active torso bleeding.