血流动力学监测与心脏超声.pptxVIP

指南解读：血流动力学监测与心脏超声（CUS） SLAX: 肋下长轴切面SIVC: 肋下下腔静脉切面PLAX：胸骨旁长轴切面PSAX: 胸骨旁短轴切面A4CH: 心尖四腔心切面CUS最常用的五个切面 Antonelli M, et al. Intensive Care Med. 2007;33(4):575-90.Cecconi M, et al. Intensive Care Med. 2014;40(12):1795-815. 25位专家组成的团队12位专家组成的团队 Five Specific Questions(1) What are the epidemiologic and pathophysiologic features of shock in the intensive care unit? (2) Should we monitor preload and fluid responsiveness in shock? (3) How and when should we monitor stroke volume or cardiac output in shock? (4) What markers of the regional and microcirculation can be monitored, and how can cellular function be assessed in shock? (5) What is the evidence for using hemodynamic monitoring to direct therapy in shock? 2014 ConsensusRecommended against常规使用: (1) the pulmonary artery catheter in shock 休克患者使用肺动脉导管(2) static preload measurements used alone to predict fluid responsiveness 仅仅使用静态的前负荷测量方法来预测液体反应性 Main differences Blood pressure statementsICM 2007ICM 2014 Fluid responsiveness statementsICM 2007ICM 2014 ICM 2007 Hemodynamic monitoringICM 2014 Cecconi M, et al. Intensive Care Med. 2014;40(12):1795-815. Main new statements(1) Statements on individualizing blood pressure targets; (2) Statements on the assessment and prediction of fluid responsiveness; (3) Statements on the use of echocardiography and hemodynamic monitoring. 2014 ConsensusIdentification of the type of shock? We recommend further hemodynamic assessment (such as assessing cardiac function) to determine the type of shock if the clinical examination does not lead to a clear diagnosis. Best practiceWe suggest that, when hemodynamic assessment is needed, echocardiography is the preferred modality to initially evaluate the type of shock as opposed to more invasive technologies. Recommendation. Level 2; QoE (B) Rationale:Context analysis (trauma, infection, chest pain, etc.) and clinical evaluation which focuses on skin perfusion and jugular vein distension usually orient diagnosis to the type of shock