Fluid management in critically ill patients: the role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance.
Fluid management in critically ill patients: the role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance.
复制标题
重症患者的流体管理：血管外肺水，腹部高血压，毛细血管渗漏和液体平衡的作用。
DOI：
10.1186/2110-5820-2-s1-s1
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发表时间：
2012
影响因子：
8.1
通讯作者：
Malbrain ML
中科院分区：
文献类型：
--
作者：
Cordemans C;De Laet I;Van Regenmortel N;Schoonheydt K;Dits H;Huber W;Malbrain ML
危重病人的毛细血管渗漏会导致间质水肿。体液过多独立地与预后不良有关。床边测量腹内压(IAP)、血管外肺水指数(EVLWI)、液体平衡和毛细血管渗漏指数(CLI)可为机械通气患者的预后提供有价值的工具。我们对123名机械通气患者进行了一项观察性研究，对ICU入院第一周的护理过程变量进行了扩展的血流动力学监测。主要的结果参数是28天的死亡率。Δ最大EVLWI表示在ICU期间两次测量的最大差值。Δ最大EVLW和−为2毫升/公斤的患者称为“应答者”。CLI定义为C反应蛋白(毫克/升)与白蛋白(克/升)的比值，保守晚期液体管理(CLFM)定义为至少连续两天液体平衡为偶数到负数。CLI有一个双阶段课程。Δ最大EVLWI值分别为(−2.4±4.8vs1.0±5.5m L/kg，p=0.001；−3.3±3.8vs2.5±5.3m L/kg，p=0.001)。无CLFM成绩与第3天CLI和IAP均值增加以及无反应风险增加相关(优势比(OR)分别为2.76，p=0.046；OR1.28，p=0.011；OR5.52，p=0.001)。应答者在第一周有更多的无呼吸机天数(2.5±2.3vs1.5±2.3，p=0.023)。未达到CLFM和无反应是死亡率的独立预测因素(OR9.34，p=0.001和OR7.14，p=0.001)。在机械通气患者中，CLI、EVLWI动力学、IAP和液体平衡似乎有重要的相关性，与器官功能障碍和预后不良有关。在此背景下，我们介绍了全球通透性增加综合症。
Capillary leak in critically ill patients leads to interstitial edema. Fluid overload is independently associated with poor prognosis. Bedside measurement of intra-abdominal pressure (IAP), extravascular lung water index (EVLWI), fluid balance, and capillary leak index (CLI) may provide a valuable prognostic tool in mechanically ventilated patients. We performed an observational study of 123 mechanically ventilated patients with extended hemodynamic monitoring, analyzing process-of-care variables for the first week of ICU admission. The primary outcome parameter was 28-day mortality. ΔmaxEVLWI indicated the maximum difference between EVLWI measurements during ICU stay. Patients with a ΔmaxEVLWI <−2 mL/kg were called 'responders'. CLI was defined as C-reactive protein (milligrams per deciliter) over albumin (grams per liter) ratio and conservative late fluid management (CLFM) as even-to-negative fluid balance on at least two consecutive days. CLI had a biphasic course. ΔmaxEVLWI was lower if CLFM was achieved and in survivors (−2.4 ± 4.8 vs 1.0 ± 5.5 mL/kg, p = 0.001; −3.3 ± 3.8 vs 2.5 ± 5.3 mL/kg, p = 0.001, respectively). No CLFM achievement was associated with increased CLI and IAPmean on day 3 and higher risk to be nonresponder (odds ratio (OR) 2.76, p = 0.046; OR 1.28, p = 0.011; OR 5.52, p = 0.001, respectively). Responders had more ventilator-free days during the first week (2.5 ± 2.3 vs 1.5 ± 2.3, p = 0.023). Not achieving CLFM and being nonresponder were strong independent predictors of mortality (OR 9.34, p = 0.001 and OR 7.14, p = 0.001, respectively). There seems to be an important correlation between CLI, EVLWI kinetics, IAP, and fluid balance in mechanically ventilated patients, associated with organ dysfunction and poor prognosis. In this context, we introduce the global increased permeability syndrome.