tailieunhanh - Báo cáo khoa học: "Predicting volume responsiveness in spontaneously breathing patients: still a challenging problem"

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: Predicting volume responsiveness in spontaneously breathing patients: still a challenging problem. | Available online http content 10 5 165 Commentary Predicting volume responsiveness in spontaneously breathing patients still a challenging problem S Magder Division of Critical Care Royal Victoria Hospital 687 Pine Avenue West Montreal Quebec Canada H3A 1A1 Corresponding author S Magder Published 11 September 2006 This article is online at http content 10 5 165 2006 BioMed Central Ltd Critical Care 2006 10 165 doi cc5029 See related commentary by Heenen et al. http content 10 4 R102 Abstract The prediction of which patients respond to fluid infusion and which patients do not is an important issue in the intensive care setting. Assessment of this response by monitoring changes in some hemodynamic characteristics in relation to spontaneous breathing efforts would be very helpful for the management of the critically ill. This unfortunately remains a difficult clinical problem as discussed in the previous issue of the journal. Technical factors and physiological factors limit the usefulness of current techniques. It is becoming increasingly apparent that excess fluid is detrimental to patient outcome 1 and that there is a limit to volume responsiveness of the heart 2 . It would therefore be potentially useful to be able to predict when volume infusions will be futile for the management of critically ill patients. Perel and colleagues 3 followed by other workers 4 introduced the use of respiratory variations in systolic pressure for the prediction of fluid responsiveness methods of detecting these variations have even been automated with monitoring devices. Based on the presumed physiological mechanism 5 however the prediction was that that these techniques probably would not work in subjects with spontaneous efforts and this was indeed supported in an earlier study by Rooke and colleagues 6 . In the previous issue of Critical Care Heenen and colleagues 7 confirmed that pulse pressure variations .