Child Debra L, Cao Zhun, Seiberlich Laura E, Brown Harold, Greenberg Jordan, Swanson Anne, Sewall Martha R, Robinson Scott B
Smiths Medical, ASD, Inc., St Paul, MN, USA.
Premier Inc., Charlotte, NC, USA.
Clinicoecon Outcomes Res. 2014 Dec 15;7:1-8. doi: 10.2147/CEOR.S72776. eCollection 2015.
Fluid overload (FO) in critically ill patients remains a challenging clinical dilemma, and many continuous intravenous (IV) medications in the US are being delivered as a dilute solution, adding significantly to a patient's daily intake. This study describes the costs and outcomes of FO in patients receiving multiple continuous infusions.
A retrospective study was conducted using a hospital administrative database covering >500 US hospitals. An FO cohort included adult intensive care unit (ICU) patients with a central line receiving IV loop diuretics and 2+ continuous IV infusions on 50%+ of their ICU days; a directly matched non-FO cohort included patients without IV diuretic use. The primary outcome of the study was total hospitalization costs per visit. Additional outcomes were ICU costs, mortality, total and ICU length of stay (LOS), 30-day readmission rates, and ventilator use. Unadjusted descriptive analysis was performed using chi-squared or paired t-tests to compare outcomes between the two cohorts.
A total of 63,974 patients were identified in each cohort. The total hospitalization cost per visit for the FO cohort was US$15,344 higher than the non-FO cohort (US$42,386 vs US$27,042), and the ICU cost for the FO cohort was US$5,243 higher than the non-FO cohort (US$10,902 vs US$5,659). FO patients had higher mortality (20% vs 16.8%), prolonged LOS (11.5 vs 8.0 days), longer ICU LOS (6.2 vs 3.6 days), higher risk of 30-day readmission (21.8% vs 21.3%), and ventilator usage (47.7% vs 28.3%) than the non-FO cohort (all P<0.05).
In patients receiving multiple continuous infusions, FO is associated with increased health care resources and costs. Maximally concentrating medications and proactively providing continuous medications in small-volume infusions (SVI) could be a potential solution to prevent iatrogenic FO in critically ill patients. Further prospective research is warranted to assess the impact of the SVI dispensing model on patient outcomes and health care costs.
重症患者的液体超负荷（FO）仍然是一个具有挑战性的临床难题，在美国，许多静脉持续用药是以稀释溶液的形式给药，这显著增加了患者的每日摄入量。本研究描述了接受多种持续输注的患者发生FO的成本和结局。
利用覆盖美国500多家医院的医院管理数据库进行了一项回顾性研究。FO队列包括在其ICU住院日的50%以上接受静脉襻利尿剂和2种及以上静脉持续输注且有中心静脉导管的成年重症监护病房（ICU）患者；直接匹配的非FO队列包括未使用静脉利尿剂的患者。该研究的主要结局是每次就诊的总住院费用。其他结局包括ICU费用、死亡率、总住院时间和ICU住院时间（LOS）、30天再入院率以及呼吸机使用情况。使用卡方检验或配对t检验进行未调整的描述性分析，以比较两个队列之间的结局。
每个队列共识别出63974例患者。FO队列每次就诊的总住院费用比非FO队列高15344美元（42386美元对27042美元），FO队列的ICU费用比非FO队列高5243美元（10902美元对5659美元）。与非FO队列相比，FO患者的死亡率更高（20%对16.8%）、住院时间延长（11.5天对8.0天）、ICU住院时间更长（6.2天对3.6天）、30天再入院风险更高（21.8%对21.3%）以及呼吸机使用率更高（47.7%对28.3%）（所有P<0.05）。
在接受多种持续输注的患者中，FO与医疗资源和成本增加相关。最大限度地浓缩药物并主动以小容量输注（SVI）方式持续给药可能是预防重症患者医源性FO的一种潜在解决方案。有必要进行进一步的前瞻性研究，以评估SVI配药模式对患者结局和医疗成本的影响。
