1 Division of Nephrology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan.
2 Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
J Intensive Care Med. 2019 Jun;34(6):495-502. doi: 10.1177/0885066617702591. Epub 2017 Apr 4.
Early fluid resuscitation is a key aspect in the successful management of critically ill patients, but the optimal goal for volume control after the acute stage of critical illness remains unclear. This study aimed to evaluate the prognostic value of bioimpedance spectrometry for fluid management in critically ill patients.
In this prospective observational study, patients who consented to participate were screened within the first 24 hours of admission to a medical intensive care unit (ICU) from February 4, 2015, to January 31, 2016. Information on demographics, comorbidities, primary reasons for admission, baseline laboratory data, and ventilator or inotropic use were documented. Data of fluid intake, fluid output, and body weight were recorded for the first 3 days of ICU admission. Bioimpedance spectrometry was performed on the first and third days after ICU admission. All participants were followed until death or hospital discharge.
Of the 140 enrolled patients (median age: 70 years, interquartile range: 60-77 years), 23 (16.4%) patients died during hospitalization. Independent predictors of hospital mortality were Acute Physiology and Chronic Health Evaluation II scores (per 1 point increase, odds ratio [OR]: 1.101) and overhydration (OH) volume on the first day (per 1 L increase, OR: 1.216). Compared to normal OH status (OH volume between -1 and 1 L), hyper OH status (OH volume < -1 L) on the third day after ICU admission was an independent predictor of hospital death (OR: 7.609). Normal OH status on the third day was associated with greater numbers of ICU-free and ventilator-free days.
Bioimpedance spectrometry can be used to predict outcomes in critically ill patients. Increased OH volume on day 1 and hyper OH volume on day 3 of ICU admission are associated with a greater risk of hospital mortality. Volume status on day 3 is associated with durations of ventilator use and ICU stay.
早期液体复苏是危重病患者成功治疗的关键环节，但在危重病急性阶段后，最佳的容量控制目标仍不清楚。本研究旨在评估生物电阻抗谱法在危重病患者液体管理中的预后价值。
这是一项前瞻性观察性研究，于 2015 年 2 月 4 日至 2016 年 1 月 31 日期间，对入住内科重症监护病房（ICU）的患者在入院后 24 小时内进行筛选。记录患者的人口统计学、合并症、入住的主要原因、基线实验室数据、呼吸机或正性肌力药物的使用情况。记录患者 ICU 入住前 3 天的液体摄入、液体输出和体重数据。ICU 入住后第 1 天和第 3 天进行生物电阻抗谱法检测。所有患者均随访至死亡或出院。
纳入的 140 例患者（中位年龄：70 岁，四分位距：60-77 岁）中，23 例（16.4%）患者在住院期间死亡。住院死亡率的独立预测因素为急性生理学与慢性健康状况评分系统 II 评分（每增加 1 分，比值比 [OR]：1.101）和 ICU 入住第 1 天的超量液体（OH）量（每增加 1 L，OR：1.216）。与正常 OH 状态（OH 量在-1 和 1 L 之间）相比，ICU 入住后第 3 天的过度 OH 状态（OH 量< -1 L）是住院死亡的独立预测因素（OR：7.609）。第 3 天正常 OH 状态与 ICU 无机械通气天数和无机械通气天数的增加相关。
生物电阻抗谱法可用于预测危重病患者的预后。ICU 入住第 1 天的 OH 量增加和第 3 天的过度 OH 量与更高的住院死亡率相关。第 3 天的容量状态与呼吸机使用时间和 ICU 入住时间有关。
