Upadya Anupama, Tilluckdharry Lisa, Muralidharan Visvanathan, Amoateng-Adjepong Yaw, Manthous Constantine A
Pulmonary and Critical Care, Bridgeport Hospital and Yale University School of Medicine, 267 Grant Street, Bridgeport, CT 06610, USA.
Intensive Care Med. 2005 Dec;31(12):1643-7. doi: 10.1007/s00134-005-2801-3. Epub 2005 Sep 29.
To examine the relationship of fluid balance and weaning outcomes.
We prospectively collected demographic, physiological, daily fluid balance (measured inputs minus outputs), and weaning data from 87 mechanically ventilated patients.
We examined 87 patients, a median age of 66 years, APACHE II of 22, and performed 205 breathing trials (BT); 38 patients (44%) were successfully extubated after their first BT with minimal or no pressure support.
Positive fluid balance (inputs>outputs) in the 24, 48, and 72 h and cumulatively (from hospital admission) prior to weaning were significantly greater in weaning failures than successes. Both univariate and multivariate analyses, adjusted for duration of mechanical ventilation and presence of chronic obstructive pulmonary disease, showed negative cumulative fluid balance 24 h prior to BTs (OR=2.9) and cumulative fluid balance (OR=3.4) to be independently associated with first-day weaning success. Similar relationships were demonstrated when all weaning attempts were analyzed. Negative fluid balance was as predictive of weaning outcomes as f/V(t) (likelihood of success was 1.7 for patients with negative fluid balance 24 h prior to weaning and 1.2 for those with f/Vt<100 min-1 l-1). Although administration of diuretics was associated with more negative fluid balance, it was not independently associated with weaning outcomes.
These data suggest that fluid balance, a potentially modifiable factor, is associated with weaning outcomes. A randomized study is required to determine whether diuresis to treat positive fluid balance expedites liberation from mechanical ventilation.
探讨液体平衡与撤机结局之间的关系。
前瞻性收集87例机械通气患者的人口统计学、生理学、每日液体平衡（测量的入量减去出量）及撤机数据。
我们研究了87例患者，中位年龄66岁，急性生理与慢性健康状况评分系统（APACHE II）评分为22，并进行了205次呼吸试验（BT）；38例患者（44%）在首次BT后以最小或无压力支持成功拔管。
撤机失败患者在撤机前24小时、48小时和72小时以及累计（从入院起）的正液体平衡（入量>出量）显著高于成功患者。单因素和多因素分析均对机械通气时间和慢性阻塞性肺疾病的存在进行了校正，结果显示BT前24小时的负累计液体平衡（比值比[OR]=2.9）和累计液体平衡（OR=3.4）与首日撤机成功独立相关。对所有撤机尝试进行分析时也显示出类似的关系。负液体平衡对撤机结局的预测作用与f/V(t)相同（撤机前24小时液体平衡为负的患者成功可能性为1.7，f/Vt<100 min-1 l-1的患者为1.2）。尽管使用利尿剂与更多的负液体平衡相关，但它与撤机结局并无独立关联。
这些数据表明，液体平衡作为一个潜在可调节的因素，与撤机结局相关。需要进行一项随机研究来确定通过利尿治疗正液体平衡是否能加速机械通气的撤离。
