medicina61巻10号

2024年09月発行

特集 内科医が知っておくべきICU・ERでの薬の使い方 腎臓・電解質

輸液製剤の使い分け

著者： 須網和也¹

所属機関： ¹JA愛知厚生連海南病院救急科

ページ範囲：P.1651 - P.1656

Point
◎敗血症や急性膵炎など大量輸液を要する場合は晶質液を用いる．
◎輸液の益と害を理解し，組織灌流の評価・輸液反応性の予測を行い，不要な輸液を減らす．
◎自由水補充は高ナトリウム血症に対して行う．
◎輸液の種類は組織灌流の低下を認める場合は細胞外液を，そうでなければ5％ブドウ糖液を補充する．

参考文献

148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg 256：18-24, 2012 PMID 22580944

2）Yunos NM, et al：Association betweena chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA 308：1566-1572, 2012 PMID 23073953

3）Raghunathan K, et al：Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis＊. Crit Care Med 42：1585-1591, 2014 PMID 24674927

4）Young P, et al：Effect of a buffered crystalloid solution vs saline on acute kidney injury among patients in the intensive care unit；The SPLIT Randomized Clinical Trial. JAMA 314：1701-1710, 2015 PMID 26444692

5）Semler MW, et al：Balanced crystalloids versus saline in the intensive care unit. The SALT Randomized Trial. Am J Respir Crit Care Med 195：1362-1372, 2017 PMID 27749094

6）Semler MW, et al；SMART Investigators and the Pragmatic Critical Care Research Group：Balanced crystalloids versus saline in critically ill adults. N Engl J Med 378：829-839, 2018 PMID 29485925

7）Self WH, et al；SALT-ED Investigators：Balanced crystalloids versus saline in noncritically ill adults. N Engl J Med 378：819-828, 2018 PMID 29485926

8）Zampieri FG, et al；BaSICS investigators and the BRICNet members：Effect of intravenous fluid treatment with a balanced solution vs 0.9％ saline solution on mortality in critically ill patients；The BaSICS randomized clinical trial. JAMA 326：1-12, 2021 PMID 34375394

9）Finfer S, et al；PLUS Study Investigators and the Australian New Zealand Intensive Care Society Clinical Trials Group：Balanced multielectrolyte solution versus saline in critically ill adults. N Engl J Med 386：815-826, 2022 PMID 35041780

10）Hammond NE, et al：Balanced crystalloids versus saline in critically ill adults；A systematic review with meta-analysis. NEJM Evid 1：EVIDoa2100010, 2022 PMID 38319180

11）Marik PE, et al：Fluid administration in severe sepsis and septic shock, patterns and outcomes；An analysis of a large national database. Intensive Care Med 43：625-632, 2017 PMID 28130687

12）Messmer AS, et al：Fluid overload and mortality in adult critical care patients；A systematic review and meta-analysis of observational studies. Crit Care Med 48：1862-1870, 2020 PMID 33009098

13）De Backer D：Detailing the cardiovascular profile in shock patients. Crit Care 21（Suppl 3）：311, 2017 PMID 29297372

14）Ltaief Z, et al：Pathophysiology and clinical implications of the veno-arterial PCO2 gap. Crit Care 25：318, 2021 PMID 34461974

15）Hernandez G, et al：Monitoring capillary refill time in septic shock. Intensive Care Med 50：580-582, 2024 PMID 38498167

16）Hernández G, et al：Effect of a resuscitation strategy targeting peripheral perfusion status vs serum lactate levels on 28-day mortality among patients with septic shock；The ANDROMEDA-SHOCK randomized clinical trial. JAMA 321：654-664, 2019 PMID 30772908

17）Monnet X, et al：Prediction of fluid responsiveness. What's new?. Ann Intensive Care 12：46, 2022 PMID 35633423

18）Monnet X, et al：How I personalize fluid therapy in septic shock?. Crit Care 27：123, 2023 PMID 36964573

19）Jacquet-Lagrèze M, et al：Capillary refill time variation induced by passive leg raising predicts capillary refill time response to volume expansion. Crit Care 23：281, 2019 PMID 31420052

20）Vincent JL, Weil MH：Fluid challenge revisited. Crit Care Med 34：1333-1337, 2006 PMID 16557164

21）Sterns RH：Disorders of plasma sodium；Causes, consequences, and correction. N Engl J Med 372：55-65, 2015 PMID 25551526

22）Kahn A, et al：Controlled fall in natremia and risk of seizures in hypertonic dehydration. Intensive Care Med 5：27-31, 1979 PMID 35558

23）Feigin E, et al：Rate of correction and all-cause mortality in patients with severe hypernatremia. JAMA Netw Open 6：e2335415, 2023 PMID 37768662