Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment-a comprehensive review.

IF 5.7 1区 医学 Q1 CRITICAL CARE MEDICINE
Carmen Andrea Pfortmueller, Wojciech Dabrowski, Rob Wise, Niels van Regenmortel, Manu L N G Malbrain
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引用次数: 0

Abstract

In this review, we aimed to comprehensively summarize current literature on pathophysiology, relevance, diagnosis and treatment of fluid accumulation in patients with sepsis/septic shock. Fluid accumulation syndrome (FAS) is defined as fluid accumulation (any degree, expressed as percentage from baseline body weight) with new onset organ-failure. Over the years, many studies have described the negative impact of FAS on clinically relevant outcomes. While the relationship between FAS and ICU outcomes is well described, uncertainty exists regarding its diagnosis, monitoring and treatment. A stepwise approach is suggested to prevent and treat FAS in patients with septic shock, including minimizing fluid intake (e.g., by limiting intravenous fluid administration and employing de-escalation whenever possible), limiting sodium and chloride administration, and maximizing fluid output (e.g., with diuretics, or renal replacement therapy). Current literature implies the need for a multi-tier, multi-modal approach to de-resuscitation, combining a restrictive fluid management regime with a standardized early active de-resuscitation, maintenance fluid reduction (avoiding fluid creep) and potentially using physical measures such as compression stockings.Trial registration: Not applicable.

Abstract Image

脓毒症和脓毒性休克的体液蓄积综合征:病理生理学、相关性和治疗--全面综述。
在这篇综述中,我们旨在全面总结有关脓毒症/脓毒性休克患者体液蓄积的病理生理学、相关性、诊断和治疗的现有文献。体液蓄积综合征(FAS)的定义是体液蓄积(任何程度,以与基线体重的百分比表示)并伴有新发器官功能衰竭。多年来,许多研究都描述了 FAS 对临床相关结果的负面影响。虽然 FAS 与重症监护室预后之间的关系已被充分描述,但其诊断、监测和治疗仍存在不确定性。建议采用循序渐进的方法来预防和治疗脓毒性休克患者的 FAS,包括尽量减少液体摄入量(例如,通过限制静脉输液和尽可能采用减量法)、限制钠和氯的摄入量以及尽量增加液体排出量(例如,使用利尿剂或肾脏替代疗法)。目前的文献表明,需要采取多层次、多模式的复苏方法,将限制性液体管理制度与标准化的早期积极复苏、维持性液体减少(避免液体攀升)相结合,并可能使用弹力袜等物理措施:试验注册:不适用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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