Li Chenglong, Wang Hong, Liu Nan, Jia Ming, Zhang Haitao, Xi Xiuming, Hou Xiaotong
1 Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
2 Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Perfusion. 2018 Nov;33(8):630-637. doi: 10.1177/0267659118780103. Epub 2018 Jun 5.
Early fluid expansion could prevent postoperative organ hypoperfusion. However, excessive fluid resuscitation adversely influences multiple organ systems. This retrospective, observational study aimed to investigate the relationship between early negative fluid balance and postoperative mortality in critically ill adult patients following cardiovascular surgery.
In total, 567 critically ill patients who had undergone cardiovascular surgery and whose intensive care unit length of stay (LOS) was more than 24 hours were enrolled. The baseline characteristics, daily fluid balance and cumulative fluid balance were obtained. Patients were followed until discharge or day 28. Multivariate logistic regressions adjusted by propensity score were used to analyze the relationship between early negative fluid balance and postoperative mortality.
Overall, postoperative mortality was 6.2% (35/567). Acute Physiology and Chronic Health Evaluation II on admission (odd ratios [OR] 1.110), acute kidney injury stage (OR 1.639) and renal replacement therapy received (OR 3.922) were the independent risk factors of postoperative mortality, whereas negative daily fluid balance at day 2 (OR 0.411) was the protective factor. Patients with a negative daily fluid balance at day 2 had lower postoperative mortality (3.4% vs. 12.2% in the positive fluid balance group), lower acute kidney injury (AKI) stage, were less likely to receive renal replacement therapy (RRT) and experienced shorter hospital LOS compared with those with a daily positive fluid balance.
This retrospective, observational study indicates that early negative fluid balance is associated with lower postoperative mortality in critically ill patients following cardiovascular surgery. Further prospective, randomized trials are needed to prove the benefits from the restrictive fluid management strategy.
早期液体扩容可预防术后器官灌注不足。然而，过度液体复苏会对多个器官系统产生不利影响。这项回顾性观察性研究旨在探讨危重症成年心血管手术患者早期负液体平衡与术后死亡率之间的关系。
总共纳入了567例接受心血管手术且重症监护病房住院时间超过24小时的危重症患者。获取了患者的基线特征、每日液体平衡和累积液体平衡情况。对患者进行随访直至出院或第28天。采用倾向评分调整的多因素逻辑回归分析早期负液体平衡与术后死亡率之间的关系。
总体而言，术后死亡率为6.2%（35/567）。入院时的急性生理与慢性健康状况评分II（比值比[OR] 1.110）、急性肾损伤分期（OR 1.639）和接受肾脏替代治疗（OR 3.922）是术后死亡的独立危险因素，而术后第2天的每日负液体平衡（OR 0.411）是保护因素。与每日液体平衡为正的患者相比，术后第2天每日液体平衡为负的患者术后死亡率更低（3.4% vs. 正液体平衡组的12.2%）、急性肾损伤（AKI）分期更低、接受肾脏替代治疗（RRT）的可能性更小且住院时间更短。
这项回顾性观察性研究表明，早期负液体平衡与危重症心血管手术患者较低的术后死亡率相关。需要进一步进行前瞻性随机试验来证实限制性液体管理策略的益处。
