关注危重病人液体平衡(定稿)课件.pptVIP

关注危重病人液体平衡;目录;;Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock ;Patient randomized N=263;CVP: central venous pressure MAP: mean arterial pressure ScvO2: central venous oxygen saturation;;质疑点;CVP监测能准确指导液体复苏吗？;Objective: A systematic review of the literature to determine the following: the relationship between CVP and blood volume, the ability of CVP to predict fluid responsiveness, the ability of the change in CVP (CVP) to predict fluid responsiveness.;The pooled correlation coefficient between the CVP and measured blood volume was 0.16 (95% CI, 0.03 to 0.28; r= 0.02).;1、The pooled correlation coefficient between baseline CVP and change in stroke index/cardiac index was 0.18 2、The pooled area under the ROCcurve was 0.56 3、The pooled correlation between CVP and change in stroke index/cardiac index was 0.11 4、The baseline CVP was 8.7 -2.3mm Hg in the responders, as compared to 9.7 - 2.2mm Hg in nonresponders (not signficant; p 0.3).;结论;Fluid Resuscitation in Septic shockA Positive Fluid Balance and Elevated Central Venous Pressure Are Associated With Increased Mortality;12h液体平衡与CVP有关联，24小时就没有关联;CVP Group;Stop filling patients against central venous pressure, please!*;Lees N, Hamilton M, Rhodes A: Clinical review: Goal-directed therapy in high risk surgical patients. Crit Care 2009; 13:231 ;修正的EGDT试验 1.镇静镇痛 2.液体反应性：CVP动态变化；对于正压通气患者SVV/PPV 3.滴定MAP75~85mmHg 4.P(cv-a)CO2 5.血管活性药撤离试验;血管活性药物撤离试验;液体超负荷，我们要重视的问题！;Payen S, etal,for the Sepsis Occurrence in Acutely Ill Patients (SOAP)Investigators: A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care 12: R74, 2008;Fluid Resuscitation in Septic shockA Positive Fluid Balance and Elevated Central Venous Pressure Are Associated With Increased Mortality;12h液体正平衡4.2 ± 3.8 L 第四天液体正平衡11 ± 8.9 L ;;1、2与4相比，死亡率下降 3与4相比，有下降，但无统计学意义;CVP Group;Vincent JL,et al: Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 200