Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia.
Monash University, Commercial Road, Melbourne, VIC, 3004, Australia.
Intensive Care Med. 2017 Jun;43(6):795-806. doi: 10.1007/s00134-017-4772-6. Epub 2017 Mar 25.
The administration of chloride-rich intravenous (IV) fluid and hyperchloraemia have been associated with perioperative renal injury. The aim of this study was to determine whether a comprehensive perioperative protocol for the administration of chloride-limited IV fluid would reduce perioperative renal injury in adults undergoing cardiac surgery.
From February 2014 through to December 2015, all adult patients undergoing cardiac surgery within a single academic medical center received IV fluid according to the study protocol. The perioperative protocol governed all fluid administration from commencement of anesthesia through to discharge from the intensive care unit and varied over four sequential periods, each lasting 5 months. In periods 1 and 4 a chloride-rich strategy, consisting of 0.9% saline and 4% albumin, was adopted; in periods 2 and 3, a chloride-limited strategy, consisting of a buffered salt solution and 20% albumin, was used. Co-primary outcomes were peak delta serum creatinine (∆S) within 5 days after the operation and KDIGO-defined stage 2 or stage 3 acute kidney injury (AKI) within 5 days after the operation.
We enrolled and analysed data from 1136 patients, with 569 patients assigned to a chloride-rich fluid strategy and 567 to a chloride-limited one. Compared with a chloride-limited strategy and adjusted for prespecified covariates, there was no association between a chloride-rich perioperative fluid strategy and either peak ∆S , transformed to satisfy the assumptions of multivariable linear regression [regression coefficient 0.03, 95% confidence interval (CI) -0.03 to 0.08); p = 0.39], or stage 2 or 3 AKI (adjusted odds ratio 0.97, 95% CI 0.65-1.47; p = 0.90].
A perioperative fluid strategy to restrict IV chloride administration was not associated with an altered incidence of AKI or other metrics of renal injury in adult patients undergoing cardiac surgery.
Clinicaltrials.gov Identifier: NCT02020538.
富含氯的静脉（IV）输液和高氯血症与围手术期肾损伤有关。本研究旨在确定在接受心脏手术的成年人中，是否采用限制氯的 IV 液的综合围手术期方案会减少围手术期肾损伤。
从 2014 年 2 月至 2015 年 12 月，在一家学术医疗中心内接受心脏手术的所有成年患者均根据研究方案接受 IV 液。围手术期方案从麻醉开始到从重症监护病房出院期间管理所有输液，方案分为四个连续阶段，每个阶段持续 5 个月。在第 1 期和第 4 期采用富含氯的策略，包括 0.9%生理盐水和 4%白蛋白；在第 2 期和第 3 期采用限制氯的策略，包括缓冲盐溶液和 20%白蛋白。主要结局为术后 5 天内的血清肌酐峰值变化（∆S）和术后 5 天内的 KDIGO 定义的 2 期或 3 期急性肾损伤（AKI）。
我们纳入并分析了 1136 例患者的数据，其中 569 例患者接受富含氯的液体策略，567 例患者接受限制氯的液体策略。与限制氯的围手术期液体策略相比，并根据预设协变量进行调整，富含氯的围手术期液体策略与血清肌酐峰值变化无关（转换为满足多变量线性回归假设后的回归系数为 0.03，95%置信区间为-0.03 至 0.08；p=0.39），也与 2 期或 3 期 AKI 无关（调整后的比值比为 0.97，95%置信区间为 0.65-1.47；p=0.90）。
在接受心脏手术的成年患者中，限制 IV 氯输液的围手术期液体策略与 AKI 发生率或其他肾脏损伤指标的变化无关。
Clinicaltrials.gov 标识符：NCT02020538。
