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Báo cáo y học: "Detecting volume responsiveness and unresponsiveness in intensive care unit patients: two different problems, only one solution"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Detecting volume responsiveness and unresponsiveness in intensive care unit patients: two different problems, only one solution. | Available online http ccforum.eom content 13 4 175 Commentary Detecting volume responsiveness and unresponsiveness in intensive care unit patients two different problems only one solution Jean-Louis Teboul1 2 and Xavier Monnet1 2 1Service de réanimation medicale CHU Bicetre AP-HP Le Kremlin-Bicetre F-94270 France 2EA 4046 faculte de médecine Paris-Sud Univ Paris-Sud Le Kremlin-Bicêtre F-94270 France Corresponding author Jean-Louis Teboul jean-louis.teboul@bct.aphp.fr Published 10 August 2009 This article is online at http ccforum.com content 13 4 175 2009 BioMed Central Ltd Critical Care 2009 13 175 doi 10.1186 cc7979 See related research by Thiel et al. http ccforum.com content 13 4 R111 Abstract Policies of fluid administration restriction in critically ill patients have evolved over recent years. Abundant fluid resuscitation is encouraged during the early stage of severe sepsis. But a conservative fluid strategy is recommended in later stages in particular when lungs are injured. Both strategies are risky if uncontrolled. Tests detecting volume unresponsiveness at any moment of fluid resuscitation or detecting volume unresponsiveness at any moment of fluid restriction would help to better assess the benefit risk ratio of continuing such strategies. Measuring the short-term hemodynamic changes during passive leg raising can be reliably used for that purpose in both situations even when patients are breathing spontaneously. In this issue of Critical Care Thiel and colleagues 1 present a new method for tracking the changes in cardiac output in response to passive leg raising PLR one of the tests recently proposed to predict volume responsiveness in critically ill patients 2 . Recent review articles have emphasised the relevance of using dynamic indices such as pulse pressure variation and stroke volume variation for that purpose 3-5 . Nevertheless the respiratory variation of stroke volume cannot be used in cases of spontaneous breathing 6 7 or low tidal volume .