Fluid Replacement in Treatment of Hypovolemia and Shock: Crystalloids and Colloids

Yıl 2013, Cilt: 22 Sayı: 3, 347 - 361, 01.09.2013

Fatih Yıldız , Emre Karakoç

Öz

Shock is a pathologic state with high mortality rate and characterized by a reduction of systemic tissue perfusion and decresead oxygen delivery. Absolute or relative hypovolemia is a common pathology of most shock types. Correction of hypovolemia might reverse the disturbance and increase the tissue perfusion. Fluid resuscitation with crystalloid and colloid solutions can carry the risk of increasing morbidity and mortality if not used properly. Although crystalloid and colloid solutions are considered to have equal efficacy and safety profile, recent studies showed that this assumption may not be correct. Early and effective management of hypovolemia is the cornerstone of shock resuscitation. Initial management of patients with septic shock and hypovolemia should be done with 30ml/kg of crystalloids. Proper fluid replacement and resuscitation algoritms might increase the sürvival rate.

Anahtar Kelimeler

Hypovolemia, Crystalloid, Colloid, Fluid therapy, Sepsis, Shock

Hipovolemi ve Şok Tedavisinde Sıvı Seçimi: Kristalloid ve Kolloidler

Öz

Şok yüksek mortalite ile seyreden erken ve hızlı müdahale gerektiren bir patolojidir. Dolaşım sisteminin dokuların metabolik substrat ihtiyacını karşılamaması olarak tanımlanabilecek şok tiplerinin bir çoğunda ortak nokta mutlak veya relatif hipovolemidir. Hipovoleminin düzeltilmesi için sıkça kullanılan kristalloid ve kolloid solusyonlar, uygun kullanılmadıkları zaman morbiditeyi ve mortaliteyi artırma riski taşıyabilmektedirler. Yakın zamanlara kadar uzlaşı rehberlerinde kristalloid ve kolloid solusyonlar eşit etkinlik ve güvenlik profiline sahip olarak belirtilmesine rağmen, yeni çalışmalar bu varsayımın doğru olmayabileceğini göstermiştir. Hipovolemi'de sıvı replasmanının hızlı ve etkin yapılması en uygun tedavi yaklaşımıdır. Septik şok ve hipovolemisi olan hastaların başlangıç sıvı yönetimi 30ml/kg kristalloid ile yapılmalıdır. Uygun sıvı seçimi ve resüsitasyon algoritmaları hastaların sağ kalım şansını artırabilmektedir.

Anahtar Kelimeler

Hipovolemi, Kristalloid, Kolloid, Sıvı tedavisi, Sepsis, Şok

Kaynakça

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