tailieunhanh - Báo cáo khoa học: "Can passive leg raising be used to guide fluid administration"

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: Can passive leg raising be used to guide fluid administration? | Available online http content 10 6 170 Commentary Can passive leg raising be used to guide fluid administration Daniel De Backer Department of Intensive Care Erasme University Hospital Route de Lennik 808 B-1070 Brussels Belgium Corresponding author Daniel De Backer ddebacke@ Published 8 November 2006 This article is online at http content 10 6 170 2006 BioMed Central Ltd Critical Care 2006 10 170 doi cc5081 See related research by Lafanechere et al. http content 10 4 R132 Abstract Predicting fluid responsiveness has become a topic of major interest. Measurements of intravascular pressures and volumes often fail to predict the response to fluids even though very low values are usually associated with a positive response to fluids. Dynamic indices reflecting respiratory-induced variations in stroke volume have been developed however these cannot be used in patients with arrhythmia or with spontaneous respiratory movements. The passive leg raising PLR test has been suggested to predict fluid responsiveness. PLR induces an abrupt increase in preload due to autotransfusion of blood contained in capacitance veins of the legs which leads to an increase in cardiac output in preload-dependent patients. This commentary discusses some of the technical issues related to this test. In many instances hemodynamic optimization requires the use of fluids. However the response to fluids may be quite variable and cannot be adequately predicted from the measurements of intravascular pressures central venous pressure or pulmonary artery pressure 1 or volumes. Indeed the relationship between stroke volume and preload varies considerably between the patients. Accordingly extreme values only can predict fluid responsiveness. Dynamic indices reflecting respiratory-induced variations in stroke volume have been developed 2 but these cannot be used in patients with cardiac arrhythmias or in patients with spontaneous respiratory movements 3

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