6 24 1C 1. CVP 8~12 mmhg 2. MAP 65 mmhg 3. 0.5 ml 4. 70% 65% 1 colloid crystalloid 1B SAFE albumin 2 813 386 07-346-8278 07-350-5220 E-mail shoalin01@.gmail.com 21
p=0.09 prospective meta-analysis 3-5 volume of distribution resuscitation CVP 8 mmhg 12 mmhg 1C hypovolemia 30 500~1000 300~500 fluid challenge intravascular volume overload hypoperfusion CVP balloon-occluded pressure 1D fluid challenge initial volume expansion period CVP bedside 6,7 venodilationcapillary leak 24 input output / vasopressor MAP 65 mmhg 1C mean arterial pressure auto-regulation 8,9 norepinephrine 65 mmhg 9 65 mmhg norepinephrine dopamine CVP CVP 1C 22
catecholamine dopamine epinephrine splanchnic circulation Phenylephrine stroke volume epinephrine dopamine norephinephrine epinephrine Phenylephrine adrenergic agent Dopamine stroke volume heart rate cardiac output stroke volume heart rate dopamine Dopamine Dopamine Dopamine 10 norepinephrine vasopressin 0.03 units/min norepinephrine 2C vasopressin 11 vasopressin 12-16 24~48 17 24 dopamine inotropic chronotropic vasopressin hepatosplanchnic flow 18 vasopressin cardiac output dopamine 1A metaanalysis Dopamine placebo peak serum creatinine 19,20 dopamine arterial line 1D pressure cuff 23
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HEMODYNAMIC SUPPORT: FLUID THERAPY, VASOPRESSOR AND INOTROPICS Shoa-Lin Lin Abstract Despite spectacular advances in life-support technology, the management of patients with severe sepsis continues to be a significant health care challenge because of the associated major morbidity and high mortality. Standard therapy for patients with septic shock includes antibiotics, infection source control, and hemodynamic support with fluids and vasoactive medications. Early goal-directed resuscitation has been shown to improve survival for emergency department patients presenting with septic shock in a randomized, controlled study. Resuscitation directed toward the early goals for the initial 6-hr period of the resuscitation has been reported to be able to reduce 28-day mortality rate. This report focuses on the fluid therapy, vasopressor and inotropic supports. Other portions of management of patients with severe sepsis will be introduced by other specialists. Key words: Fluid therapy, Hemodynamic, Inotropics, Sepsis, Vasopressor Correspondence: Dr. Shoa-Lin Lin Intensive Care Unit, Kaohsiung Veterans General Hospital, No.386, Ta-Chung 1st Rd., Kaohsiung City813, Taiwan, Phone: 886-7-346-8278; Fax: 886-7-350-5220; E-mail: shoalin01@gmail.com 26