感染性休克的液体复苏.pptVIP

谢谢 * * * * * * * * * * Conclusions: This systematic review demonstrated a very poor relationship between CVP and blood volume as well as the inability of CVP/ΔCVP to predict the hemodynamic response to a fluid challenge. CVP should not be used to make clinical decisions regarding fluid management. Marik PE et al.Chest. 2008;134(1):172-8. Discussion In other words, our results suggest that at any CVP the likelihood that CVP can accurately predict fluid responsiveness is only 56% (no better than flipping a coin). Furthermore, an AUC of 0.56 suggests that there is no clear cutoff point that helps the physician to determine if the patient is “wet” or “dry”. Marik PE et al.Chest. 2008;134(1):172-8. Discussion It is important to emphasize that a patient is equally likely to be fluid responsive with a low or a high CVP. The results from this study therefore confirm that neither a high CVP, a normal CVP, a low CVP, nor the response of the CVP to fluid loading should be used in the fluid management strategy of any patient. Marik PE et al.Chest. 2008;134(1):172-8. Discussion It should also be recognized that CVP was a component of early goal-directed therapy in the landmark article by Rivers and colleagues. However, both the control and intervention groups had CVP targeted to 8 to 12mm Hg. Marik PE et al.Chest. 2008;134(1):172-8. Discussion Based largely on the results of the early goal-directed therapy study, the Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock recommend a CVP of 8 to 12mmHg as the “goal of the initial resuscitation of sepsis-induced hypoperfusion” and “a higher targeted central venous pressure of 12–15 mmHg” in patients receiving mechanical ventilation. Marik PE et al.Chest. 2008;134(1):172-8. Discussion The results of our study suggest that these recommendations should be revisited. Marik PE et al.Chest. 2008;134(1):172-8. MAP≥65 mmHg? Emanuel Rivers et al.N Engl J Med 2001;345:1368-77 tonometry PCO2 gap red cell