TAILIEUCHUNG - Báo cáo y học: "Fluids in septic shock: too much of a good thing"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Fluids in septic shock: too much of a good thing? | Groeneveld Critical Care 2010 14 101 http content 14 1 101 CRITICAL CARE COMMENTARY L__ Fluids in septic shock too much of a good thing AB Johan Groeneveld See related research by Brandt etal http content 13 6 R186 Abstract In a recent issue of Critical Care Brandt and colleagues report the effects of a liberal fluid loading protocol compared to a more restrictive protocol on hemodynamics and mortality in pigs in which septic shock had been induced. It appears that the former protocol was associated with higher mortality in spite of improved hemodynamics compared to the latter. The results of the paper are discussed here in view of the scope and mechanisms of these findings. With regard to fluid resuscitation they indicate that too much of an otherwise good thing is harmful even if overhydration and edema formation seem to have been prevented. They also do not exclude a specific toxic effect of the larger volumes of hydroxyethyl starch in the liberal strategy. The precise nature of a toxic effect remains obscure however but may involve the kidneys. Introduction In a recent issue of Critical Care Brandt and coworkers 1 performed fluid resuscitation on pigs with endotoxemia or fecal peritonitis using either moderate volumes of crystalloids 10 ml kg h or larger volumes of crystalloids supplemented by 130 hydroxyethyl starch combined 20 ml kg h . These protocols were designed to mimic the relative restrictive and liberal fluid resuscitation policies that have been previously compared in human major surgery and acute lung injury acute respiratory distress syndrome 2-4 . In both sepsis models mortality increased with liberal fluid loading protocols in spite of better haemodynamic stabilization. This interesting study raises a number of questions. Volume and type of fluid in the resuscitation from sepsis Although supplemental hydroxyethyl starch use in both study arms was partially goal-directed - on the basis of Correspondence .

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