Alison Fahey, Patrick J Neligan, Bairbre McNicholas
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引用次数: 0
摘要
审查目的:急性肾损伤(AKI)与静脉输液治疗一样,是重症监护医学中经常遇到的问题。输液与急性肾损伤之间存在相互作用,既可能是积极的,也可能是消极的。了解输液的生理原理非常重要,有助于临床医生在考虑对 AKI 患者或有 AKI 风险的患者进行输液治疗;这包括了解输液的选择、监测方法、给药和临床后遗症:人们越来越关注结合静态和动态测量方法来评估液体平衡、液体反应性和液体疗法的效果,这些都是需要持续研究的领域,以便将这一理论转化为床边临床实用实践。虽然在 ICU 实践中关于晶体液选择的争论仍在继续,但国际指南和对之前进行的试验进行的患者数据荟萃分析进一步证明了平衡溶液的益处。摘要:本综述评估了在患有各种类型 AKI 的 ICU 队列中使用液体的生理学原理,以及使用多种不同变量选择液体疗法的系统方法,旨在帮助指导临床医生管理 AKI 重症患者的液体使用和液体平衡。
Purpose of review: Acute kidney injury (AKI) is commonly encountered in critical care medicine as is intravenous fluid therapy. It is accepted that there is interplay between fluid use and AKI, both potentially positive and negative. An understanding of the physiological rationale for fluid is important to help clinicians when considering fluid therapy in patients with, or at risk for AKI; this includes understanding choice of fluid, method of monitoring, administration and clinical sequelae.
Recent findings: There is increasing interest in combining both static and dynamic measures to assess fluid balance, fluid responsiveness effects of fluid therapy, which are areas requiring ongoing study to translate this theory into clinically useful practice at the bedside. Whilst the debate of choice of crystalloid in ICU practice continues, further evidence for benefits for balanced solutions emerges in the form of international guidelines and patient data meta-analysis of previously performed trials.
Summary: This review assesses the physiological rationale for fluid use in ICU cohorts with AKI of various types, as well as a systematic approach for choice of fluid therapy using a number of different variables, which aims to help guide clinicians in managing fluid use and fluid balance in critically ill patients with AKI.
期刊介绍:
Current Opinion in Critical Care delivers a broad-based perspective on the most recent and most exciting developments in critical care from across the world. Published bimonthly and featuring thirteen key topics – including the respiratory system, neuroscience, trauma and infectious diseases – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.