容量负荷试验x

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1、FluidChallengeRevisitedBinDu,MDMedicalICU,PekingUnionMedicalCollegeHospitalWhyFluidChallengeacutelyillpatientsfrequentlyrequirefluidrepletionhypovolemiaexternalloss:bleeding,gastrointestinal,urinarytracts,skininternalloss:extravasationofblood,exudation/transudationoffluidsRelativehypovolemia:incre

2、asesvenouscapacitancesepsis,drugsvolumerepletionessentialrestorecriticallevelsofcardiacoutputandarterialpressure,morenormalperfusionofvitalorgansandtissuesWhyFluidChallengeWhyFluidChallengeClinicalexamination:limitedsensitivity&specificityhistoryphysicalsignsroutinelaboratorytestsAnygivenleveloffi

3、llingpressure↓→morelikelyhypovolemia↑→morelikelyright/leftheartfailureneithersufficientlyreliableCVP&PAOPCVP<8mmHgCVP<12mmHgsensitivity62%(95%CI49-73%)82%(95%CI70-90%)specificity54%(95%CI43-56%)28%(95%CI19-39%)PPV51%47%NPV65%67%PAOP<11mmHgPAOP<12mmHgsensitivity77%(95%CI65-87%)77%(95%CI65-87%)speci

4、ficity51%(95%CI40-62%)51%(95%CI40-62%)PPV54%54%NPV74%74%OsmanD,RidelC,RayP,etal.Cardiacfillingpressuresarenotappropriatetopredicthemodynamicresponsetovolumechallenge.CritCareMed2007;35:64-68FluidChallenge:WhenExtravascularvolumedeficitsdonotbecomeclinicallyapparentuntiltheyexceed10%ofbodyweightCO=

5、SVXHRnonspecificsignLackofreliabilitybasedonastaticmeasurementFluidChallenge:WhenAmbulatorypatientFunctionalHemodynamicsSystolicpressurevariation(SPV)Strokevolumevariation(SVV)Pulsepressurevariation(PPV)Respiratorysystolicvariationtest(RSVT)Respiratory-inducedIVCdiameterchangereliablymeasuredonlyd

6、uringCMVtidalvolumedependentunreliablymeasuredduringarrhythmiaaffectedbydecreasedchestwallcompliancemisleadingduringrightheartfailureWhoNeedFluidChallengeMichardF,TeboulJL.PredictingfluidresponsivenessinICUpatients.Acriticalanalysisoftheevidence.Chest2002;121:2000-2008FluidChallenge:WhatFluidCollo

7、id:4%gelatin6%hetastarch5%albuminCrystalloid:0.9%normalsalinevs.vanderHeijdenVerheijJ,vanNieuwAmerongenGP,etal.Crystalloidorcolloidfluidloadingandpulmonarypermeability,edema,andinjuryinsepticandnonsepticcriticall