1Depawwrtment of Anesthesiology, Duke University Medical Center, Durham, NC. 2Durham VA Medical Center, Durham, NC. 3OptiStatim LLC, Longmeadow, MA. 4Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC. 5Department of Medicine, Baystate Medical Center, Springfield, MA. 6Department of Medicine, Duke University School of Medicine, Durham, NC. 7Center for Quality of Care Research and Department of Medicine, Baystate Medical Center and Tufts University School of Medicine, Springfield, MA.
Crit Care Med. 2014 Jul;42(7):1585-91. doi: 10.1097/CCM.0000000000000305.
Isotonic saline is the most commonly used crystalloid in the ICU, but recent evidence suggests that balanced fluids like Lactated Ringer's solution may be preferable. We examined the association between choice of crystalloids and in-hospital mortality during the resuscitation of critically ill adults with sepsis.
A retrospective cohort study of patients admitted with sepsis, not undergoing any surgical procedures, and treated in an ICU by hospital day 2. We used propensity score matching to control for confounding and compared the following outcomes after resuscitation with balanced versus with no-balanced fluids: in-hospital mortality, acute renal failure with and without dialysis, and hospital and ICU lengths of stay. We also estimated the dose-response relationship between receipt of increasing proportions of balanced fluids and in-hospital mortality.
Three hundred sixty U.S. hospitals that were members of the Premier Healthcare alliance between November 2005 and December 2010.
A total of 53,448 patients with sepsis, treated with vasopressors and crystalloids in an ICU by hospital day 2 including 3,396 (6.4%) that received balanced fluids.
None.
Patients treated with balanced fluids were younger and less likely to have heart or chronic renal failure, but they were more likely to receive mechanical ventilation, invasive monitoring, colloids, steroids, and larger crystalloid volumes (median 7 vs 5 L). Among 6,730 patients in a propensity-matched cohort, receipt of balanced fluids was associated with lower in-hospital mortality (19.6% vs 22.8%; relative risk, 0.86; 95% CI, 0.78, 0.94). Mortality was progressively lower among patients receiving larger proportions of balanced fluids. There were no significant differences in the prevalence of acute renal failure (with and without dialysis) or in-hospital and ICU lengths of stay.
Among critically ill adults with sepsis, resuscitation with balanced fluids was associated with a lower risk of in-hospital mortality. If confirmed in randomized trials, this finding could have significant public health implications, as crystalloid resuscitation is nearly universal in sepsis.
等张生理盐水是 ICU 中最常用的晶体液，但最近的证据表明，平衡液如乳酸林格氏液可能更优。我们研究了在复苏脓毒症危重症成人时选择晶体液与院内死亡率之间的关系。
一项回顾性队列研究，纳入了未接受任何手术且在 ICU 中治疗至入院后第 2 天的脓毒症患者。我们使用倾向评分匹配来控制混杂因素，并比较了复苏后使用平衡液与非平衡液的以下结局：院内死亡率、有或无透析的急性肾衰，以及住院和 ICU 住院时间。我们还估计了接受平衡液比例增加与院内死亡率之间的剂量反应关系。
Premier Healthcare 联盟的 360 家美国医院，研究时间为 2005 年 11 月至 2010 年 12 月。
共纳入 53448 例脓毒症患者，在 ICU 中接受血管加压素和晶体液治疗，其中 3396 例（6.4%）接受了平衡液。
无。
接受平衡液治疗的患者更年轻，且发生心脏病或慢性肾衰竭的可能性更小，但更可能接受机械通气、有创监测、胶体、类固醇和更大剂量的晶体液（中位数 7 比 5 L）。在倾向评分匹配队列中的 6730 例患者中，接受平衡液与较低的院内死亡率相关（19.6%比 22.8%；相对风险，0.86；95%CI，0.78，0.94）。接受更多平衡液的患者死亡率逐渐降低。有或无透析的急性肾衰的发生率以及院内和 ICU 住院时间均无显著差异。
在脓毒症危重症成人中，使用平衡液复苏与较低的院内死亡率相关。如果在随机试验中得到证实，这一发现可能具有重要的公共卫生意义，因为晶体液复苏在脓毒症中几乎普遍应用。
Zotero 插件