Fluid Therapy

  • June 2020
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Fluid Therapy •Peripheral vein •Needle No.16, 18 •Rate - Fluid loading - Fluid challenge test

Fluid Loading • Concurrent loss • >1200 ml/hr • Free flow

Fluid Challenge Test • Right & left ventricle •

หลัง จา กให้ สาร นำำา

หลัง จา กรอ 10 นา ที

CVP(cm H 2 O)

PC WP (mm Hg )

Fl uid Therap y

<8

<10

200mL in 10 min

8-12

10-14

100mL in 10 min

>12

>14

50mL in 1o min

CVP(c mH 2 O)

PCWP(m mHg )

Flui d t hera py

>5

>7

หยุดให้สารนำำา พิจารณา vasoactive drug

<2

<3

ให้สารนำำาต่อไป

2<<5

3<<7

รอ 10 นาที

ยังคง >2

ยังคง>3

หยุดให้สารนำำา พิจารณา vasoactive drug

<2

<3

ให้สารนำำาต่อไป

Fluid Challenge Test • CVP=JVP+5cmH2O • Rate – LVEF – Lung parenchyma • crystalloids • 1mmHg=1.36cmH2O • Fluid overload – S3 gallop – Fine crepitation

• CVP – Concurrent loss – Capillary leakage – vasoconstriction

Crystalloids • • • •

Normal Saline Ringer’s lactate solution Ringer’s acetate solution Others

Normal saline/0.9%NaCl/NSS Attention! • Volume overload • Hypernatremia • Hyperchlotemic metabolic acidosis

Ringer’s lactate solution/RLS Attention! • Volume overload • Lactic acidosis • Hyperkalemia • Hypercalcemia

Ringer’s acetate solution

• ให้ในผู้ป่วยโรคตับได้

Others • Hypotonic solution – NSS/2 – 5%DW – 5%D/NSS/2 • Hypertonic solution – 3%NaCl

Colloids • Gelatin – Haemaccel – Gelofusine – Gelifundol • Starch – 6%HES – 10%HES • Dextran – Dextran-40 – Dextran-70 • Albumin – 5%albumin – 25%albumin

Colloids Attention! • Anaphylactic/ anaphylactoid reaction • Renal toxicity • Coagulopathy/ platelet dysfunction

Crystalloids or Colloids? • • • •

Fluid compartment Visceral edema Serum albumin Adverse reaction

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