Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Institute of Medical Informatics, UMIT: University for Health Sciences, Biomedical Informatics and Mechatronics, Medical Informatics and Technology, Hall i.T, Austria.
Crit Care Med. 2019 Jul;47(7):e555-e562. doi: 10.1097/CCM.0000000000003775.
Optimal fluid management is important in patients with acute brain injury, including subarachnoid hemorrhage. We aimed to examine the relationship between daily fluid intake and fluid balance with hospital complications and functional outcome.
Retrospective observational cohort study.
Neurocritical care unit at a tertiary academic medical center.
Two-hundred thirty-seven consecutive nontraumatic subarachnoid hemorrhage patients admitted to the neurologic ICU between 2010 and 2016.
Total daily amount of fluids and fluid balance were calculated over 15 days. Using multivariate generalized estimating equation models the association of daily fluid intake and fluid balance with disease severity, hospital complications and poor functional outcome (3-mo modified Rankin Score ≥ 3) was investigated. Additionally, we described the composition of fluids given.
Patients presented with a median admission Hunt and Hess grade of 3 (interquartile range, 1-5) and were 57 years old (interquartile range, 47-67 yr old). A higher daily fluid intake was associated with higher admission Hunt and Hess grade (odds ratio, 1.61; 95% CI, 1.47-1.76; p < 0.001), increased pulmonary fluid accumulation (adjusted odds ratio, 1.11; 95% CI, 1.01-1.21; p = 0.033), prolonged mechanical ventilation (Wald statistic = 20.08; degrees of freedom = 1; p < 0.001), higher daily Subarachnoid hemorrhage Early Brain Edema Score (adjusted odds ratio, 1.11; 95% CI, 1.01-1.22; p = 0.034), occurrence of anemia (adjusted odds ratio, 1.36; 95% CI, 1.20-1.54; p < 0.001), delayed cerebral ischemia (adjusted odds ratio, 1.31; 95% CI, 1.14-1.51; p < 0.001), and poor functional outcome (adjusted odds ratio, 1.25; 95% CI, 1.10-1.41; p < 0.001). Daily fluid balance was associated with higher admission Hunt and Hess grade (odds ratio, 1.09; 95% CI, 1.05-1.13; p < 0.001) and anemia (adjusted odds ratio, 1.17; 95% CI, 1.03-1.33; p = 0.019). The main contributors to fluids were nutritional compounds (31%), IV drugs (30%), and volume substitution (17%).
Our study demonstrates a significant association of fluid intake but not fluid balance with hospital complications and poor functional outcome in subarachnoid hemorrhage patients. A larger prospective study is needed to confirm our results.
在急性颅脑损伤患者（包括蛛网膜下腔出血）中，优化液体管理非常重要。本研究旨在探讨每日液体摄入量与液体平衡与医院并发症和功能预后之间的关系。
回顾性观察性队列研究。
三级学术医疗中心的神经重症监护病房。
2010 年至 2016 年间连续入住神经重症监护病房的 237 例非创伤性蛛网膜下腔出血患者。
计算了 15 天内的总日液体量和液体平衡。使用多变量广义估计方程模型，研究了每日液体摄入量和液体平衡与疾病严重程度、医院并发症和不良功能预后（3 个月改良 Rankin 评分≥3）之间的关系。此外，我们还描述了所给予的液体组成。
患者入院时的中位 Hunt 和 Hess 分级为 3 级（四分位距，1-5），年龄为 57 岁（四分位距，47-67 岁）。较高的每日液体摄入量与较高的入院 Hunt 和 Hess 分级（比值比，1.61；95%置信区间，1.47-1.76；p<0.001）、肺液蓄积增加（调整比值比，1.11；95%置信区间，1.01-1.21；p=0.033）、机械通气时间延长（Wald 统计量=20.08；自由度=1；p<0.001）、每日蛛网膜下腔出血早期脑肿胀评分升高（调整比值比，1.11；95%置信区间，1.01-1.22；p=0.034）、贫血发生（调整比值比，1.36；95%置信区间，1.20-1.54；p<0.001）、迟发性脑缺血（调整比值比，1.31；95%置信区间，1.14-1.51；p<0.001）和不良功能预后（调整比值比，1.25；95%置信区间，1.10-1.41；p<0.001）有关。每日液体平衡与较高的入院 Hunt 和 Hess 分级（比值比，1.09；95%置信区间，1.05-1.13；p<0.001）和贫血（调整比值比，1.17；95%置信区间，1.03-1.33；p=0.019）有关。液体的主要来源是营养化合物（31%）、IV 药物（30%）和容量替代（17%）。
本研究表明，蛛网膜下腔出血患者的液体摄入量与液体平衡与医院并发症和不良功能预后显著相关。需要更大的前瞻性研究来证实我们的结果。
