[课件]休克补液辩论：晶体液首选PPT

1998-2004 Comments in BMJ
SAFE研究: 4% Albumin vs Normal Saline （Saline versus Albumin Fluid Evaluation） 双盲随机对照，28天死亡率评估 澳大利亚新西兰16个ICU，共6997个病人
28天病死率
(n=3497) (n=3500)
Βιβλιοθήκη Baidu
N Engl J Med 2004;350(22):2247-2256
不同病人群体亚组分析
Trauma 亚组分析
Albumin 创伤 (N=1186) 13.6 24.5 6.2 NS 10.0 15.1 6.2 RR ( 95% CI ) 1.36 (0.99-1.86) 1.62 (1.12-2.34) 1.00 (0.56-1.79) p 0.06 0.01 1.00
伴颅脑伤 (N=492) 不伴颅脑伤 (N=694)
(HES vs Ringer’s lactate)
Efficacy of Volume Substitution and Insulin Therapy in Severe Sepsis
VISEP Study (HES vs Ringer’s lactate)
VISEP Study (HES vs Ringer’s lactate)
The need for renal-replacement therapy and 90-day mortality were significantly correlated with the cumulative dose of HES (P<0.001 and P = 0.001, respectively) but not with the dose of Ringer’s lactate (P = 0.11 and P = 0.31, respectively).
Subjects： Patients were deemed to be eligible if the onset of the syndrome was less than 24 hours before admission to the ICU or less than 12 hours after admission if the condition developed in the ICU.
HES group： HES until a limit of 20 mL/kg/day, then preferentially Ringer’s or other non-colloid fluids RL group：Ringer’s lactate
VISEP Study (HES vs Ringer’s lactate)
VISEP Study (HES vs Ringer’s lactate)
VISEP Study (HES vs Ringer’s lactate)
VISEP Study (HES vs Ringer’s lactate)
P=0.007 between HES doses P=0.345 between Ringer‘s lactate doses
Subjects: 30 randomised controlled trials including1419 randomised patients.
Sesults： Pooled difference in the risk of death with albumin was 6% (95% confidence interval 3% to 9%) with a fixed effects model. These data suggest that for every 17 critically ill patients treated with albumin there is one additional death. Conclusions: There is no evidence that albumin administration reduces mortality in critically ill patients with hypovolaemia, burns, or hypoalbuminaemia and a strong suggestion that it may increase mortality.
Conclusion: Albumin increase the risk of mortality by 6%
Design: Systematic review of randomised controlled trials of resuscitation with colloids compared with crystalloids for volume replacement of critically ill patients. Subjects: 37 randomised controlled trials Type of injury: Trauma, Burns, Surgery, Septic and hypovolaemic shock, ARDS, Vascular leak syndrome
休克补液辩 论：晶体液 首选
液体复苏包括三个主题
1，液体种类的选择 2，复苏策略（量） 3，复苏程度endpoints （度）
Design: Systematic review of randomised controlled trials comparing administration of albumin or plasma protein fraction with no administration or with administration of crystalloid solution in critically ill patients with hypovolaemia, burns, or hypoalbuminaemia.