严重创伤患者的液体复苏fluidresuscitationintraumaticcriticallyillpatients.pptVIP

Fluid Resuscitation in Traumatic Critically Ill Patients Aug 21, 2006 Ri 林 殿 閔 Patterns of Traumatic Injury Penetrating injury – ongoing significant blood loss is expected Blunt injury – blood loss may be occult or contained and significant or limited Head injury – maintenance of cerebral perfusion pressure Others: pediatric and obstetric trauma Shock Definition: a state of reduced organ perfusion resulting in tissue hypoxia and organ dysfunction S/S: falling of BP, tachycardia, oligouria, decreased mental status, decreased peripheral pulses, diaphoresis Main goal of therapy: rapid resuscitation with re-establishment of tissue perfusion using fluid therapy and vasoactive drugs Hemorrhagic shock Acute response: Increased capillary permeability Reduction in blood flow Sympathetic compensation by peripheral vasoconstriction Elevated IL-6 and TNF-alpha Tissue hypoperfusion and anaerobic metabolism/acidosis After systemic circulation is restored, reperfusion injury due to free oxygen radicals released during acute hypoxic stage may occur Traumatic hemorrhagic shock Acute stage: hemorrhagic shock May be accompanied with : Cardiogenic shock Neurogenic shock Obstructive shock Septic shock Hemorrhagic shock Traumatic hemorrhagic shock Trauma triad of death after hemorrhagic shock: (1) Hypothermia (2) Acidosis (3) Coagulopathy Traumatic hemorrhagic shock Phase 1: The period from injury to definite surgical care and homeostasis Phase 2: The period during and immediately after definite surgical procedure Phase 3: The period in ICU following definitive care and characterized by established critical illness Phase 1: pre-hospital /pre-operative fluid therapy Traumatic hypotension without a head injury: no evidence suggest that pre-hospital fluids are beneficial Delayed fluid resuscitation has better outcome than immediate resuscitation in penetrating torso injuries The evidence supporting delayed or