Faculdade de Medicina, Hospital Universitário San Ignacio, Bogotá, Colômbia.
Rev Bras Ter Intensiva. 2020 Mar;32(1):99-107. doi: 10.5935/0103-507x.20200015. Epub 2020 May 8.
To assess whether fluid overload in fluid therapy is a prognostic factor for patients with septic shock when adjusted for lactate clearance goals.
This was a retrospective cohort study conducted at a level IV care hospital in Bogotá, Colombia. A cohort of patients with septic shock was assembled. Their characteristics and fluid balance were documented. The patients were stratified by exposure levels according to the magnitude of fluid overload by body weight after 24 hours of therapy. Mortality was determined at 30 days, and an unconditional logistic regression model was created, adjusting for confounders. The statistical significance was established at p ≤ 0.05.
There were 213 patients with septic shock, and 60.8% had a lactate clearance ≥ 50% after treatment. Ninety-seven (46%) patients developed fluid overload ≥ 5%, and only 30 (13%) developed overload ≥ 10%. Patients exhibiting fluid overload ≥ 5% received an average of 6227mL of crystalloids (SD ± 5838mL) in 24 hours, compared to 3978mL (SD ± 3728mL) among unexposed patients (p = 0.000). The patients who developed fluid overload were treated with mechanical ventilation (70.7% versus 50.8%) (p = 0.003), albumin (74.7% versus 55.2%) (p = 0.003) and corticosteroids (53.5% versus 35.0%) (p = 0.006) more frequently than those who did not develop fluid overload. In the multivariable analysis, cumulative fluid balance was not associated with mortality (OR 1.03; 95%CI 0.89 - 1.20).
Adjusting for the severity of the condition and adequate lactate clearance, cumulative fluid balance was not associated with increased mortality in this Latin American cohort of septic patients.
评估在调整乳酸清除目标后，液体治疗中的液体超负荷是否为感染性休克患者的预后因素。
这是一项在哥伦比亚波哥大的四级护理医院进行的回顾性队列研究。组建了一个感染性休克患者队列。记录了他们的特征和液体平衡情况。根据治疗后 24 小时内按体重计算的液体超负荷程度，将患者分层为暴露水平。在 30 天时确定死亡率，并创建一个无条件逻辑回归模型，调整混杂因素。统计显著性设定为 p ≤ 0.05。
共有 213 例感染性休克患者，60.8%的患者在治疗后乳酸清除率≥50%。97 例（46%）患者出现液体超负荷≥5%，仅 30 例（13%）患者出现超负荷≥10%。出现液体超负荷≥5%的患者在 24 小时内接受了平均 6227 毫升的晶体液（标准差±5838 毫升），而未暴露的患者接受了 3978 毫升（标准差±3728 毫升）（p=0.000）。发生液体超负荷的患者接受机械通气的比例（70.7%对 50.8%）（p=0.003）、白蛋白（74.7%对 55.2%）（p=0.003）和皮质类固醇（53.5%对 35.0%）（p=0.006）的频率高于未发生液体超负荷的患者。在多变量分析中，累积液体平衡与死亡率无关（比值比 1.03；95%置信区间 0.89-1.20）。
在调整病情严重程度和充分的乳酸清除率后，累积液体平衡与该拉丁美洲感染性休克患者队列的死亡率增加无关。
