A 35-year-old man has been admitted for severe pancreatitis. He received an aggressive fluid resuscitation of more than 6 liters of normal saline. Because he was having trouble breathing, he was intubated, and a nasogastric tube and Foley catheter were inserted. His abdominal pressure is now 35 cm H2O. Head of bed is 30 degrees. Peak airway pressures are rising, and his urine output has decreased to less than 30 mL/hour.
Which of the following is the most appropriate next step in this patient’s management?
A. Call surgery to transfer him to the operating room.
B. Chemically paralyze him with appropriate sedation.
C. Place him in reverse Trendelenburg position.
D. Try to perform paracentesis with an indwelling catheter.
E. Start a furosemide infusion with albumin or mannitol.
答案解析：
腹内高压的治疗应从微创进展到最有创。此外，应进行操作以防止侵入性操作。对于这个患者来说，下一步最合适的是要走镇静他。床头在30度，他仍然有腹内高压，因此头高脚低位没有帮助。由于静脉回流受损，呋塞米输注即使在白蛋白或甘露醇治疗中也无济于事，并可能使肾功能恶化。
正确答案：B
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