ARDS患者液体管理策略.ppt

Comparison of Two Fluid-Management Strategies in Acute Lung Injury. N Engl J Med 2006;354:2564-75. The cumulative fluid balance during the first seven days was –136±491 ml in the conservative-strategy group and 6992±502 ml in the liberal-strategy group (P0.001) The rate of death at 60 days was 25.5 percent in the conservative-strategy group and 28.4 percent in the liberal-strategy group (P = 0.30; 95 percent confidence interval for the difference, ?2.6 to 8.4 percent) As compared with the liberal strategy, the conservative strategy increased the number of ventilator free days (14.6±0.5 vs. 12.1±0.5, P0.001) and days not spent in the intensive care unit (13.4±0.4 vs. 11.2±0.4, P0.001) during the first 28 days but did not increase the incidence or prevalence of shock during the study or the use of dialysis during the first 60 days (10 percent vs. 14 percent, P = 0.06) Comparison of Two Fluid-Management Strategies in Acute Lung Injury. N Engl J Med 2006;354:2564-75. Figure 3. Change in body weight over the first seven days of conservative vs. liberal fluid management in ALI patients in FACTT. Differences were statistically different from day 1 through day 7. After seven days, patients in the liberal arm had gained approximately 7 kg while those in the conservative arm were near their baseline weight. Figure 4. Patients in FACTT who received conservative fluid management had approximately 3 more days alive and free of mechanical ventilation requirement (ventilator free days) during the first 28 days of study. Figure 5. Whether managed with a central venous catheter or a pulmonary artery catheter, patients receiving conservative fluid management required significantly fewer red cell transfusions. The bars illustrate the percentage of patients who did not require any red cell transfusions during the first seven days of study. Figure 6. Bars show percentage of patients who never developed hypotension vs. those who developed hypotension during the first 7 days of study in