Bihari Shailesh, Prakash Shivesh, Potts Simon, Matheson Elisha, Bersten Andrew D
Department of Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, SA, Australia.
Crit Care Resusc. 2018 Dec;20(4):285-293.
Inadvertent fluid loading - and resultant sodium and chloride - is common in critically ill patients. Sources such as fluid used as vehicles for drug infusions and boluses (fluid creep) and maintenance fluid are a common cause. We hypothesised that total sodium and chloride loading can be safely reduced in critically ill patients both by the use of 5% glucose as a diluent for infusions and boluses, when possible, and by its use as a maintenance fluid.
This was a prospective before-and-after study design in a single centre tertiary mixed intensive care unit (ICU). Comprehensive data about patient demographics, sources of fluid, feeds, intravenous drugs, fluid balance and electrolyte levels were collected for 4 weeks before and after the intervention (2016 and 2017). The amount of administered sodium was estimated from these sources.
There were 146 patients (643 study days) and 133 patients (684 study days) examined in 2016 and 2017 respectively. The change of practice lead to an increase in the use of 5% glucose as the maintenance fluid and as a diluent, which resulted in a decrease in the total daily administered sodium from a median of 197 mmol (interquartile range [IQR], 155-328 mmol) to a median of 109 mmol (IQR, 77-288 mmol) ( = 0.0001). It also resulted in decrease in daily fluid balance, plasma chloride and ICU-acquired hypernatraemia.
It is safely possible to decrease the total sodium and chloride loading to ICU patients by intervening on fluid creep and on maintenance fluid types. This intervention was accompanied by favourable changes in serum electrolyte and fluid balance.
在重症患者中，不经意间的液体负荷以及由此导致的钠和氯负荷很常见。诸如用作药物输注和推注载体的液体（液体缓慢渗漏）以及维持液等来源是常见原因。我们假设，通过尽可能使用5%葡萄糖作为输注和推注的稀释剂，并将其用作维持液，可以安全地减少重症患者的总钠和氯负荷。
这是一项在单中心三级混合重症监护病房（ICU）进行的前瞻性前后对照研究设计。在干预前后（2016年和2017年）的4周内收集了有关患者人口统计学、液体来源、喂养、静脉用药、液体平衡和电解质水平的综合数据。从这些来源估算钠的给药量。
2016年和2017年分别检查了146例患者（643个研究日）和133例患者（684个研究日）。实践的改变导致5%葡萄糖作为维持液和稀释剂的使用增加，这使得每日总钠给药量从中位数197 mmol（四分位间距[IQR]，155 - 328 mmol）降至中位数109 mmol（IQR，77 - 288 mmol）（ = 0.0001）。这也导致每日液体平衡、血浆氯和ICU获得性高钠血症减少。
通过干预液体缓慢渗漏和维持液类型，安全地降低ICU患者的总钠和氯负荷是可行的。这种干预伴随着血清电解质和液体平衡的有利变化。
