ARDS患者液体管理策略分析.pptVIP

AIFR was defined as the administration of an initial fluid bolus of ≥ 20 mL/kg prior to vasopressor therapy initiation and the achievement of a central venous pressure of ≥ 8 mm Hg within 6 h after vasopressor therapy initiation.11 CLFM was defined as even-to-negative fluid balance on at least 2 consecutive days during the first 7 days after septic shock onset. * Rivers E. N Engl J Med. 2001 Nov 8;345(19):1368-77. PiCCO监测提供容量负荷、心脏后负荷、心肌收缩力、肺水含量等信息 因此，低血容量休克时若以大量晶体液进行复苏，可以引起血浆蛋白稀释以及胶体渗透压下降，同时出现组织水肿 因此，成功治疗肺水肿取决于能否正确回答下列问题 Thus, the success of our therapy often depends on the correct answers to the following questions: (1) 肺组织水分是多少 (1) How much water is in the lungs, (2) 为何会有肺水肿 (2) Why is it there, (3) 如何使肺组织水分回到正常水平 (3) What can we do to return lung water to the normal limits Lung is a fairly dry place Make them dry Increase EVLW by only 200-300ml – ALI In ALI mortality approaches 100% if EVLW 14.3 ml/kg PBW on day 1 Make them dry Evidence strongly suggests for most patients with ALI/ARDS who are not in shock using: 1. Diuretics 2. Fluid restriction 3. Albumin and furosemide in selected patients with hypoproteinemia and ALI 2. Want to know precisely what is happening to lung water with resuscitative and therapeutic interventions * ICU医生面对的患者多合并不同系统的疾患，治疗结果往往不取决于医生治疗的强项，而是短项 不合理治疗导致功亏一篑 AQP1 is expressed throughout the microvascular endothelia in airways and lung；AQP3 in basal cell plasma membranes in nasopharnyx, trachea, and large bronchi; and AQP4 at the basolateral plasma membrane of columnar surface epithelial cells in small and large airways；AQP5 is expressed at the luminal membrane of type I alveolar epithelial cells Schematic diagrams representing aquaporins in rat airway and glandular tissues. A: alveolus contains AQP5 (red) in apical membranes of type I pneumocytes (P1); AQP1 (green) is sparsely present in underlying capillary endothelium. Although a pathway is defined linking airspace and vascular space, no known aquaporin has been identified in