ICM:欧洲重症医学会关于成年重症患者液体治疗的临床实践指南：复苏液体的选择

Abstract

Purpose: This is the first of three parts of the clinical practice guideline from the European Society of Intensive Care Medicine (ESICM) on resuscitation fluids in adult critically ill patients. This part addresses fluid choice and the other two will separately address fluid amount and fluid removal.

目的：这是欧洲重症医学会（ESICM）关于成人危重症患者复苏液体的临床实践指南三部分中的第一部分。本部分讨论液体选择，另外两部分将分别讨论液体用量和液体清除。

Methods: This guideline was formulated by an international panel of clinical experts and methodologists. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was applied to evaluate the certainty of evidence and to move from evidence to decision.

方法：本指南由国际临床专家和方法学家小组制定。采用推荐意见分级的评估、制定与评价（GRADE）方法评估证据确定性，并从证据转化为决策。

Results: For volume expansion, the guideline provides conditional recommendations for using crystalloids rather than albumin in critically ill patients in general (moderate certainty of evidence), in patients with sepsis (moderate certainty of evidence), in patients with acute respiratory failure (very low certainty of evidence) and in patients in the perioperative period and patients at risk for bleeding (very low certainty of evidence). There is a conditional recommendation for using isotonic saline rather than albumin in patients with traumatic brain injury (very low certainty of evidence). There is a conditional recommendation for using albumin rather than crystalloids in patients with cirrhosis (very low certainty of evidence). The guideline provides conditional recommendations for using balanced crystalloids rather than isotonic saline in critically ill patients in general (low certainty of evidence), in patients with sepsis (low certainty of evidence) and in patients with kidney injury (very low certainty of evidence). There is a conditional recommendation for using isotonic saline rather than balanced crystalloids in patients with traumatic brain injury (very low certainty of evidence). There is a conditional recommendation for using isotonic crystalloids rather than small-volume hypertonic crystalloids in critically ill patients in general (very low certainty of evidence).

结果：对于容量复苏，指南提出以下有条件推荐：

一般危重症患者（中等证据确定性）、脓毒症患者（中等证据确定性）、急性呼吸衰竭患者（极低证据确定性）以及围手术期和有出血风险的患者（极低证据确定性），建议使用晶体液而非白蛋白；
创伤性脑损伤患者（极低证据确定性），建议使用等渗盐水而非白蛋白；
肝硬化患者（极低证据确定性），建议使用白蛋白而非晶体液；
一般危重症患者（低证据确定性）、脓毒症患者（低证据确定性）和肾损伤患者（极低证据确定性），建议使用平衡晶体液而非等渗盐水；
创伤性脑损伤患者（极低证据确定性），建议使用等渗盐水而非平衡晶体液；
一般危重症患者（极低证据确定性），建议使用等渗晶体液而非小剂量高渗晶体液。