[肝病患者何时应入住重症监护室?]

IF 1.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-07-17 DOI:10.1007/s00063-024-01160-w
Eda Kaya, Patrick Nekarda, Isabella Traut, Philipp Aurich, Ali Canbay, Antonios Katsounas
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引用次数: 0

摘要

肝脏疾病是全球发病率和死亡率的重要原因。肝硬化可导致出血、肝性脑病(HE)和感染等严重并发症。实施明确的重症监护室(ICU)入院管理策略可改善患者的预后。血流动力学意义上的食管/胃静脉曲张出血(E/GVB)和 4 级肝性脑病(HE),如果同时需要肾脏替代疗法(RRT),则是入住重症监护病房的明确指征。E/GVB、自发性细菌性腹膜炎(SBP)和多重耐药菌(MDRO)感染需要进行严密和严格的重症评估。严重肝肾综合征(HRS)或呼吸衰竭患者的基线死亡率会升高,最有可能受益于 ICU 的早期治疗。快速识别肝硬化患者的败血症是入住重症监护病房的重要标准。根据死亡风险和临床紧急程度确定病例的优先次序,可以有效利用资源,优化患者管理。此外,"肝病病房 "还为需要密切监测但不需要立即接受重症监护的肝病患者提供中间监护(IMC)级别。
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[When should a liver disease patient be admitted to the intensive care unit?]

Liver diseases are a significant global cause of morbidity and mortality. Liver cirrhosis can result in severe complications such as bleeding, hepatic encephalopathy (HE), and infections. Implementing a clear strategy for intensive care unit (ICU) admission management improves patient outcomes. Hemodynamically significant esophageal/gastric variceal bleeding (E/GVB) and grade 4 HE, when accompanied by the need for renal replacement therapy (RRT), are definitive indications for ICU admission. E/GVB, spontaneous bacterial peritonitis (SBP), and infections with multidrug-resistant organisms (MDRO) require close and stringent critical assessment. Patients with severe hepatorenal syndrome (HRS) or respiratory failure have increased baseline mortality and most likely benefit from early ICU treatment. Rapid identification of sepsis in patients with liver cirrhosis is a crucial criterion for ICU admission. Prioritizing cases based on mortality risk and clinical urgency enables efficient resource utilization and optimizes patient management. In addition, "Liver Units" provide an intermediate care (IMC) level for patients with liver diseases who require close monitoring but do not need immediate intensive care.

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来源期刊
CiteScore
2.60
自引率
9.10%
发文量
93
审稿时长
6-12 weeks
期刊介绍: Medizinische Klinik – Intensivmedizin und Notfallmedizin is an internationally respected interdisciplinary journal. It is intended for physicians, nurses, respiratory and physical therapists active in intensive care and accident/emergency units, but also for internists, anesthesiologists, surgeons, neurologists, and pediatricians with special interest in intensive care medicine. Comprehensive reviews describe the most recent advances in the field of internal medicine with special focus on intensive care problems. Freely submitted original articles present important studies in this discipline and promote scientific exchange, while articles in the category Photo essay feature interesting cases and aim at optimizing diagnostic and therapeutic strategies. In the rubric journal club well-respected experts comment on outstanding international publications. Review articles under the rubric "Continuing Medical Education" present verified results of scientific research and their integration into daily practice. The rubrics "Nursing practice" and "Physical therapy" round out the information.
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