Effectsoffluidresuscitationwithsyntheticcolloidsorcrystalloids.docVIP

Effects of fluid resuscitation with synthetic colloids or crystalloids alone on shock reversal, fluid balance, and patient outcomes in patients with severe sepsis: A prospective sequential analysis* 在脓毒症患者纠正休克时单独使用人工胶体或晶体液的液体复苏效果以及患者预后：前瞻性序贯分析 Bayer, Ole MD; Reinhart, Konrad MD; Kohl, Matthias PhD; Kabisch, Bj?rn PhD; Marshall, John MD; Sakr, Yasser MD, PhD; Bauer, Michael MD; Hartog, Christiane MD; Schwarzkopf, Daniel; Riedemann, Niels MD Objective: To assess shock reversal and required fluid volumes in patients with septic shock. 目的：评估脓毒性休克患者的休克救治和液体需要量 ? Design: Prospective before and after study comparing three different treatment periods. 设计：比较三个不同治疗时间段的前瞻性前后对照研究。 ? Setting: Fifty-bed single-center surgical intensive care unit. 机构：单中心50张床的外科ICU。 ? Patients: Consecutive patients with severe sepsis. 患者：连续入住的严重脓毒症患者。 ? Interventions: Fluid therapy directed at preset hemodynamic goals with hydroxyethyl starch (predominantly 6% hydroxyethyl starch 130/0.4) in the first period, 4% gelatin in the second period, and only crystalloids in the third period. 干预：第一阶段使用羟乙基淀粉（主要为6%羟乙基淀粉130/0.4）血流动力学目标进行液体治疗，第二阶段使用4%明胶，第三阶段只用晶体液。 ? Measurements and Main Results: Main outcome was time to shock reversal (serum lactate 2.2 mmol/L and discontinuation of vasopressor use). Hemodynamic goals were mean arterial pressure 70 mm Hg; ScvO2 70%; central venous pressure 8 mm Hg. Safety outcomes were acute kidney injury defined by Risk, Injury, Failure, Loss, and End-stage kidney disease criteria and new need for renal replacement therapy. Hemodynamic measures, serum lactate, and creatinine were comparable at baseline in all study periods (hydroxyethyl starch n = 360, gelatin n = 352, only crystalloids n = 334). Severity scores, hospital length of stay, and intensive care unit or hospital mortality did not differ significantly among groups. All groups showed similar time to shock reversal. More fluid was needed over the first 4 days in the crystalloid group (fluid ratios 1.4:1 [crystall