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關注危重病人液體平衡(定稿)(已修改)

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【正文】關注危重病人液體平衡 ? 徐穎鶴第一頁，共六十一頁。目錄 ? EGDT提高搶救成功率 ? 液體超負荷增加危重病人死亡率 ? CVP監測能準確指導液體復蘇嗎？ ? 白蛋白用于液體復蘇新觀點第二頁，共六十一頁。 Early GoalDirected Therapy (EGDT): involves adjustments of cardiac preload, afterload, and contractility to balance O2 delivery with O2 demand Chest 1992。101:1644. 第三頁，共六十一頁。 Early GoalDirected Therapy in the Treatment of Severe Sepsis and Septic Shock Rivers E, Nguyen B, Havstad S, et al. Early goaldirected therapy in the treatment of severe sepsis and septic shock. NEJM 2024。345:1368. Study purpose: to evaluate the efficacy of early goaldirected therapy in patients presenting to an emergency department with severe sepsis or septic shock (prior to ICU admission) Study design: prospective, randomized controlled, partially blinded, single center trial 第四頁，共六十一頁。 Patient randomized N=263 Early goal directed therapy N=130 Standard therapy N=133 CVP 812 mm Hg MAP 65 mm Hg Urine Output ml/kg/hr CVP 812 mm Hg MAP 65 mm Hg Urine Output ml/kg/hr ScvO2 70% SaO2 93% Hct 30% Antibiotics given at discretion of treating clinicians As soon as possible Mean ICU MDs blinded to study treatment NEJM 2024。345:136877. At least 6 hours of EGDT Mean 8hrs Transfer to ICU 第五頁，共六十一頁。 CVP: central venous pressure MAP: mean arterial pressure ScvO2: central venous oxygen saturation Early GoalDirected Therapy NEJM 2024。345:136877. 第六頁，共六十一頁。第七頁，共六十一頁。第八頁，共六十一頁。 % % 0 10 20 30 40 50 60 Standard Therapy N=133 EGDT N=130 P = * *Key difference was in sudden CV collapse, not MODS Early GoalDirected Therapy Results: 28 Day Mortality Sudden CV Collapse MODS 21% vs 10% p= 22% vs 16% P= NEJM 2024。345:136877. Mortality 第九頁，共六十一頁。質疑點質疑點質疑點第十頁，共六十一頁。 CVP監測能準確指導液體復蘇嗎？第十一頁，共六十一頁。 Objective: A systematic review of the literature to determine the following: (1)the relationship between CVP and blood volume, (2) the ability of CVP to predict fluid responsiveness, (3) the ability of the change in CVP (CVP) to predict fluid responsiveness. 第十二頁，共六十一頁。 The pooled correlation coefficient between the CVP and measured blood volume was (95% CI, to 。 r= ). 第十三頁，共六十一頁。 The pooled correlation coefficient between baseline CVP and change in stroke index/cardiac index was The pooled area under the ROCcurve was The pooled correlation between CVP and change in stroke index/cardiac index was The baseline CVP was Hg in the resp

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