ICU 或脓毒血症液体复苏.ppt

ICU 或脓毒血症液体复苏;内容提要;Introduction to the ICU and sepsis;Specialist hospital wards providing intensive treatment and monitoring for patients who are critically ill or in an unstable condition ;是一种危及生命的疾病 是对感染损伤组织和器官的反应 如不及时治疗 ;定义;Sepsis is a major healthcare problem in terms of resources and expenditure1;Principles of severe sepsis management;白蛋白: rationale for use in the ICU/severe sepsis;Hypo白蛋白aemia is significantly more common in non-surviving sepsis patients;Hypo白蛋白aemia: a significant independent predictor of AKI, and death after AKI development;白蛋白: effects on mortality in sepsis and severe sepsis;白蛋白 vs saline in severe sepsis: SAFE study subgroup;CI, confidence interval; OR, odds ratio; SAFE, Saline versus 白蛋白 Fluid Evaluation*Multivariate analysis after adjustment for baseline characteristics, in patients with complete baseline data SAFE Study Investigators. Intensive Care Med 2011; 37: 86–96;SAFE study subgroup: 白蛋白 vs saline in volume expansion;Cost-effectiveness of 白蛋白: SAFE study subgroup;Delaney et al. meta-analysis: 白蛋白 significantly lowers risk of mortality vs other fluids in sepsis ;白蛋白 reduces the risk of mortality vs control in sepsis ;Wiedermann et al. meta-analysis: relationship between hyperoncotic 白蛋白 and AKI;OR 0.52 (95% CI 0.28, 0.95);Outlook: 白蛋白 in sepsis trials;白蛋白: possible non-oncotic mechanisms accountable for the benefit in sepsis;Benefit of 白蛋白 in sepsis: possible non-oncotic mechanisms;Antioxidant activity of 白蛋白 in sepsis;Treatment example: volume resuscitation of septic shock – goal MAP 65 mmHg;HES: effects on mortality, kidney function and bleeding – evidence from recent landmark trials and meta-analyses;HES 130/0.42 vs Ringer’s acetate (6S study): safety and efficacy in severe sepsis?;HES 130/0.42 significantly increases risk of mortality and RRT vs Ringer’s acetate in severe sepsis;HES 130/0.42 significantly increases risk of bleeding vs Ringer’s acetate in severe sepsis;HES 130/0.4 vs saline (CHEST study): safety and