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在fluid resuscitation guidelines這個產品中，有4篇Facebook貼文，粉絲數超過7萬的網紅臨床筆記，也在其Facebook貼文中提到， Surviving Sepsis Guidelines 2016 改版摘要 初步復甦 3小時內給予 Crystalloid fluid ≥ 30 ml/kg 復甦目標 MAP > 65 mmHg, lactate 降至正常 EGDT, CVP, ScvO2 不再被建議用來評估復甦成效！...

fluid resuscitation guidelines 在 臨床筆記 Facebook 的最佳貼文

臨床筆記 By 臨床筆記

2017-02-05 00:47:15 有 156 人按讚
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Surviving Sepsis Guidelines 2016 改版摘要

初步復甦
3小時內給予 Crystalloid fluid ≥ 30 ml/kg
復甦目標 MAP > 65 mmHg, lactate 降至正常
EGDT, CVP, ScvO2 不再被建議用來評估復甦成效！
改以非侵入性動態指標監測

Initial Resuscitation
☑ Crystalloid fluid ≥ 30 ml/kg within the first 3 hrs
☐ Target MAP ≥ 65 mmHg
☐ Normalize lactate
☒ EGDT, CVP, ScvO2

Antimicrobial Therapy
☐ Empiric broad-spectrum antibiotics within 1 hr
☐ Procalcitonin to support the discontinuation of antibiotics

Fluid Therapy
☑ Crystalloids ± albumin
☒ HESs

Vasopressors
☑ Norepinephrine ± vasopressin or epinephrine

Corticosteroids
☐ Hydrocortisone 200 mg per day for refractory shock

Blood Products
☐ pRBC: Hb < 7
☐ platelet: 10K, 20K, 50K

Glucose Control
☐ Target blood glucose ≤ 180 mg/dl

Bicarbonate Therapy
☐ pH < 7 .15

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這裡是心臟內科及重症專科醫師 林世崇的醫療筆記部落格，提供實用的臨床醫療資訊，歡迎分享！
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fluid resuscitation guidelines 在 臨床筆記 Facebook 的最讚貼文

臨床筆記 By 臨床筆記

2017-01-21 08:05:21 有 174 人按讚
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敗血性休克使用輸液急救的指引，很好用，一目瞭然。

PS：除了文謅謅的論文寫作之外，這種圖表式的流程圖最能表達理念及作法指引。
任何一篇實務性的長篇大論，若是無法以這種流程圖(Algorithm)來表達作者理念，就是有兩種原因，第一，作者本身還沒完全搞清楚他在寫些什麼；第二，就是這篇文章跟本沒有健全結構，無法呈現Algorithmm。

PS again, 有時候學生學習不佳，考試成績差，實務應用差，授課老師也是有責任的。

A users’ guide to the 2016 Surviving Sepsis Guidelines

Two aspects of the guidelines should be understood. We illuminate these two aspects through an analysis of the priority currently assigned to early identification and initial treatment of sepsis, including antibiotics and fluid therapy.

First, the recommendation for antibiotic administration within an hour of diagnosis of sepsis is a lofty goal of care, judged to be ideal for the patient but not yet standard care. Despite the best intentions of the healthcare team, antibiotic administration within 1 h from time of diagnosis may be difficult due to the complexity of the hospital environment and essential care being delivered to other patients during the same time period by the same healthcare practitioners and health system. This is one among several “aspirational recommendations” considered by the experts to represent best practice that individual practitioners and healthcare teams should strive to operationalize.

Second, the clinician may push back from use of recommendations for fear that evidence-based guidelines lead to “cookie cutter” medicine and reflexive behaviors that deemphasize the “art” of medicine. The recommendations are intended for a “typical” septic patient. Patients still benefit from the art of medicine, which includes interpretation of data and individualization of treatment. The recommendations provide much-needed general treatment guidance to the bedside decision maker who is busy, pressured to see more patients in less time, and who will use a distillation of the current literature into a coherent set of recommendations suitable for the large majority of septic patients who are “typical”. For most of us in the trenches of everyday care, the lists of specific recommendations (seen in the tables in the manuscript) are a welcome adjunct to personalizing care.

This guidance includes sepsis management in the emergency department, the general hospital floors, and the ICU. For example, the recommendation for an initial 30 mL/kg crystalloid infusion for tissue hypoperfusion is chosen as a one value fit for bedside guidance. Administering 30 mL/kg crystalloid is a useful initial therapy for the majority of patients and this literature supported fluid dose is linked to good outcomes [3, 4]. Figure 2 offers guidance for initial fluid resuscitation and is built forward from the guidelines recommendation for 30 mL/kg initial crystalloid fluid administration within the first six hours for sepsis-induced tissue hypoperfusion. The flow diagram incorporates some of our own opinions for successful fluid resuscitation based on experience and our understanding of the literature.

http://rdcu.be/oGqJ

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這裡是心臟內科及重症專科醫師 林世崇的醫療筆記部落格，提供實用的臨床醫療資訊，歡迎分享！
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fluid resuscitation guidelines 在 臨床筆記 Facebook 的最佳解答

臨床筆記 By 臨床筆記

2016-08-20 19:42:40 有 153 人按讚
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【重症醫學】最實用的文章，來自歐洲重症醫學會(European Society of Intensive Care Medicine)，免費下載！

主題包括，敗血症，休克，輸液治療，急救後之照護……..

• Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012
• Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008
• Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine
• Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome
• Fluid challenges in intensive care: the FENICE study
• European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care
• A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators
• Year in review in Intensive Care Medicine 2014: I. Cardiac dysfunction and cardiac arrest, ultrasound, neurocritical care, ICU-acquired weakness, nutrition, acute kidney injury, and miscellaneous
• Combination of arterial lactate levels and venous-arterial CO2 to arterial-venous O2 content difference ratio as markers of resuscitation in patients with septic shock
• International evidence-based recommendations for point-of-care lung ultrasound

http://www.springer.com/gp/marketing/partner-power/00134p

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這裡是心臟內科及重症專科醫師 林世崇的醫療筆記部落格，提供實用的臨床醫療資訊，歡迎分享！
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