2021国际重症医学临床研究进展

International clinical research of critical care medicine in 2021

2021年重症医学的相关进展仍然鼓舞人心:时隔4年"脓毒症与感染性休克治疗国际指南"更新发布;在心肌梗死患者的限制性输血、外周静脉导管感染预防、急性呼吸窘迫综合征(ARDS)患者肝素雾化吸入与呼吸驱动压作用、低氧性呼吸衰竭(呼衰)患者的低氧合目标、非ARDS呼衰患者的低水平呼气末正压、重症患者的轻度镇静乃至非镇静策略、脓毒症与ARDS的表型研究和机器学习等方面都出现了较好的临床证据。但在液体复苏时平衡盐的使用、心肺复苏或脑外伤的低温治疗、感染性休克的肾上腺髓质素抗体adrecizumab治疗及耦联血浆滤过吸附(CPFA)疗法、急性低氧性呼衰患者实施体外二氧化碳去除(ECCO_(2)R)和中重度脑外伤患者持续输注高渗盐水等措施方面呈现阴性结论。未来,依从于"明智选择"原则的个体化诊治方案将成为重症医生日常实践的场景。

The progress of critical care medicine in 2021 is still encouraging.The new international guideline for management of sepsis and septic shock came out after 4 years.Besides,a couple of preferable clinical evidences were released including restrictive blood transfusion strategy for patients with acute myocardial infarction,prevention of peripheral venous catheter infection,heparin inhalation and driving pressure setting in patients with acute respiratory distress syndrome(ARDS),lower oxygenation target for acute hypoxemic respiratory failure,low level positive end-expiratory pressure in non-ARDS patients with respiratory failure,light sedation or non-sedation strategy,biological phenotypes,as well machine learning in sepsis and ARDS.However,we also encounter negative results such as balanced solution during fluid resuscitation,hypothermia therapy after out-of-hospital cardiac arrest or traumatic brain injury,adrenomedullin-specific antibody adrecizumab therapy and coupled plasma filtration-adsorption(CPFA)therapy for patients with septic shock,extracorporeal carbon dioxide removal(ECCO_(2)R)implementation in acute hypoxic respiratory failure,continuous infusion of hypertonic saline in patients with traumatic brain injury.Collectively,in the future,individualized diagnosis and management based on the principle of"wise choice"will become the daily practice scene for all intensivists.