Download presentation
Presentation is loading. Please wait.
Published byDaniela Powers Modified over 8 years ago
1
Société d’Anesthésie de Charleroi www.sacnet.be
2
12 Février 2008 Anesthésie et ORL : « quid de l’otologie et de la rhinologie ? « M. Van Boven JP Lechat
3
Avril 2008Anti-aggrégants et anti-plaquettaires 14 Juin 2008Atelier Echo
4
« STRATEGIE PERFUSIONNELE PERI-OPERATOIRE »
5
WET or DRY ?
8
WET or DRY ? WEANING Upadya, ICM, 2005 All ICU MV patients Prospective observation Fluid balance
9
Frutos-Vivar, Chest, 2006, 130 Prospective observation All ICU MV patients Fluid balance WET or DRY ? WEANING
10
Alsous, Chest, 2000, 117 Retrospective data collection Septic shock Fluids balance Negative fluid balance predicts survival in septic shock WET or DRY ? SURVIVAL
11
Sakr, Chest, 2005, 128 ALI-ARDS Prospective observation Fluids balance WET or DRY ? SURVIVAL
12
WET or DRY ? Humphrey, Chest, 1990, 97 Retrospective observation ARDS patients Capillary Wedge Pressure The lowest CWP consistent with a adequate CO improves ARDS survival WET or DRY ? SURVIVAL
13
Eisenberg, ARRD, 1987, 136 Prospective data collection All critically ill patients Extravascular lung water WET or DRY ? SURVIVAL
15
Hayes, NEJM, 1994, 330, 1717
16
Q f = K [(P mv – P pmv ) – ( mv - pmv )] Pressions Hydrostatiques Pressions Oncotiques
17
Q f = K [(P mv – P pmv ) – ( mv - pmv )] Pressions Hydrostatiques Pressions Oncotiques
18
Q f = K [(P mv – P pmv ) – ( mv - pmv )]
19
Q f = K [(P mv – P pmv )
21
Rivers E et al. N Engl J Med 2001;345:1368-1377
27
Martin, CCM, 2005
29
Fluid management in ALI. NEJM, 2006, 354, 2564 mean = 24 hours after ALI criteria meeting mean = 43 hours after ICU admission no severe comorbidity -Lung -Kidney -Heart no risk of death within 6 months 11.512 patients screened 10.511 patients excluded
30
Fluid management in ALI. NEJM, 2006, 354, 2564 LIBERALCVP 10-14 mmHg PAOP14-18 mmHg CONSERVATIVECVP <4 mmHg PAOP <8 mmHg
31
Fluid management in ALI. NEJM, 2006, 354, 2564
32
Cumulative at day 7 +6992+/-50 -136 +/- 491
33
Fluid management in ALI. NEJM, 2006, 354, 2564
34
Hemodynamics ! lower mean arterial pressure lower cardiac index Lung function better injury score better oxygenation index lower plateau pressure lower PEEP
35
Fluid management in ALI. NEJM, 2006, 354, 2564 Hemodynamics lower mean arterial pressure lower cardiac index Lung function better injury score better oxygenation index lower plateau pressure lower PEEP Metabolic function higher oncotic pressure, Hgb, albumine levels higher creatinine values metabolic alkalosis (hypoCl - ) electrolyte imbalance (hypoK +, hyperNa + )
36
Fluid management in ALI. NEJM, 2006, 354, 2564 Conservative strategy Improves lung function Shortens duration of MV Shortens ICU LOS
37
« In acute critical illness, treat early to achieve optimal goals and prevent MOF » Kern, CCM, 2002, 30 -Initial net positive fluid balance phase -Diuretic phase Alsous, Chest, 2000, 117
38
« Fluid management is a matter of timing » Otero, Chest, 2006, 130
39
Je me mouille !
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.