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Intravenous fluids: should we go with the flow?

机译：静脉注射液：我们应该随着流动吗？

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Sensitive monitoring should be used when prescribing intravenous fluids for volume resuscitation. The extent and duration of tissue hypoperfusion determine the severity of cellular damage, which should be kept to a minimum with timely volume substitution. Optimizing the filling status to normovolaemia may boost the resuscitation success. Macrocirculatory pressure values are not sensitive in this indication. While the Surviving Sepsis Campaign guidelines focus on these conventional pressure parameters, the guidelines from the European Society of Anaesthesiology (ESA) on perioperative bleeding management recommend individualized care by monitoring the actual volume status and correcting hypovolaemia promptly if present. The motto is: 'give what is missing'. The credo of the ESA guidelines is to use management algorithms with predefined intervention triggers. Stop signals should help in avoiding hyper-resuscitation. The high-quality evidence-based S3 guidelines on volume therapy in adults have recently been prepared by 14 German scientific societies. Statements include, for example, repeated clinical inspection including turgor of the skin and mucosa. Adjunctive laboratory parameters such as central venous oxygen saturation, lactate, base excess and haematocrit should be considered. The S3 guidelines propose the use of flow-based and/or dynamic preload parameters for guiding volume therapy. Fluid challenges and/or the leg-raising test (autotransfusion) should be performed. The statement from the Co-ordination group for Mutual Recognition and Decentralized Procedures--Human informs healthcare professionals to consider applying individualized medicine and using sensitive monitoring to assess hypovolaemia. The authorities encourage a personalized goal-directed volume resuscitation technique.
机译：应在规定体积复苏的静脉内流体时使用敏感监测。组织后灌注的程度和持续时间决定了细胞损伤的严重程度，其应与及时替代时保持最小。优化到Normovolaemia的填充状态可能会增加复苏成功。在此指示中宏观速度值不敏感。虽然幸存的败血症竞选指导方针专注于这些传统的压力参数，但欧洲麻烦学会（ESA）关于围手术期出血管理的指导方针建议通过监测实际的体积状态并及时纠正低维血症，如果存在的话。座右铭是：'给出遗失的东西'。 ESA指南的信条是使用具有预定义干预触发的管理算法。停止信号应有助于避免超复恢复。最近由14个德国科学社会制定了成人的高质量证据的S3关于成人体积疗法的指南。例如，陈述包括反复临床检查，包括皮肤和粘膜。应考虑辅助实验室参数，如中央静脉氧饱和度，乳酸盐，碱过量和血细胞比容。 S3指南提出使用用于引导体积疗法的流动和/或动态预载参数。应进行液体挑战和/或腿部饲养试验（自同种质）。协调小组的宣言，用于相互承认和分散程序 - 人类通知医疗保健专业人员考虑应用个体化药物并使用敏感监测来评估低钙血症。当局鼓励个性化目标定向卷复苏技术。

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