tailieunhanh - Critical care - Textbook (Seventh edition): Part 2

(BQ) Continued part 1, part 2 of the document Critical care - Textbook (Seventh edition) has contents: Fluid and electrolytes in pediatrics, interstitial nephritis, antibiotic stewardship, septic shock, central nervous system infections, infectious endocarditis,. and other contents. Invite you to refer. | 107 Fluid and Volume Therapy in the ICU Todd W. Robinson and Barry I. Freedman The goals of fluid administration are to optimize tissue oxygenation by augmenting intravascular volume improving left ventricular preload and increasing cardiac This chapter reviews the timing and considerations for choice of therapy in volume repletion as well as the effects of fluid volume overload in the postresuscitation period. TIMING OF INITIAL VOLUME THERAPY Studies from the early 2000s suggested that earlier recognition and treatment of septic shock correlated with improved outcomes. In a report by Rivers et al. the Early Goal-Directed Therapy Collaborative Group randomized subjects to receive either intensive treatment for septic shock within the initial 6 hours of therapy versus standard therapy provided in the emergency Standard and early goal-directed therapy EGDT groups received antibiotics vasoactive medications and intravenous IV fluid for volume resuscitation. Goals for fluid administration included infusion of crystalloid in 500-mL boluses every 30 minutes in order to achieve a central venous pressure of 8-12 mm Hg as a marker of effective repletion of intravascular volume and response to fluids. Whereas the total volume of fluid administered by 72 hours was equivalent the EGDT group received substantially more IV fluid in the first 0-6 hours of treatment. Compared with the standard therapy group significant improvements related to in-hospital mortality were observed in the group assigned to earlier administration of volume-based resuscitation in conjunction with other therapies including the optimization of central venous oxygen saturation with red cell transfusions and the use of inotropes if necessary. In-hospital mortality was in the EGDT group compared with in the standard therapy group P . Replication of results in other studies prompted guidelines for the treatment of sepsis to include early volume repletion as part of .