机械通气患者液体超负荷与谵妄/昏迷之间的关联。
Association between fluid overload and delirium/coma in mechanically ventilated patients.
作者信息
Ouchi Akira, Sakuramoto Hideaki, Hoshino Haruhiko, Matsuishi Yujiro, Sakaguchi Tatsuya, Enomoto Yuki, Hoshino Tetsuya, Shimojo Nobutake, Inoue Yoshiaki
机构信息
Department of Emergency and Critical Care Medicine Faculty of Medicine University of Tsukuba Tsukuba Japan.
Department of Adult Health Nursing College of Nursing Ibaraki Christian University Hitachi Japan.
出版信息
Acute Med Surg. 2020 Apr 15;7(1):e508. doi: 10.1002/ams2.508. eCollection 2020 Jan-Dec.
AIM
Several studies have shown an association between fluid overload (FO) and mortality or duration of mechanical ventilation in critically ill patients. However, the association between FO and delirium duration remains unclear.
METHODS
This retrospective observational cohort study was undertaken at University of Tsukuba Hospital (Tsukuba, Japan) from April 2015 to March 2017. Mechanically ventilated patients who stayed in the intensive care unit for more than 7 days were eligible for inclusion. Univariate analysis was carried out with the Mann-Whitney -test for continuous variables and Fisher's exact test for categorical variables. A multivariate proportional odds logistic regression model was used to evaluate the association between FO and delirium/coma days (DCDs) during the 7-day study period.
RESULTS
A total of 118 patients were included and divided into FO and non-FO groups. Fluid overload occurred in 40% of patients. The FO group had a higher APACHE II score than the non-FO group (19 [16-26] versus 23 [20-29], = 0.017). Cumulative fluid balance at day 3 was higher in the FO group (3,238 [281-6,530] versus 7,886 [4,106-10,631], < 0.001). Delirium days within 7 days was longer in the FO group (1 [0-3] versus 2 [1-3], = 0.048) and DCDs was longer in the FO group (4 [1-5] versus 6 [3-7], = 0.002). After adjusting for covariates, there were significant associations between FO and DCDs (odds ratio, 2.16; 95% confidence interval, 1.05-4.47).
CONCLUSIONS
Our findings suggest that FO is associated with increased DCDs in mechanically ventilated patients.
目的
多项研究表明，液体超负荷（FO）与危重症患者的死亡率或机械通气时间有关。然而，FO与谵妄持续时间之间的关联仍不明确。
方法
本回顾性观察队列研究于2015年4月至2017年3月在筑波大学医院（日本筑波）进行。入住重症监护病房超过7天的机械通气患者符合纳入标准。连续变量采用曼-惠特尼检验进行单因素分析，分类变量采用费舍尔精确检验。采用多变量比例优势逻辑回归模型评估7天研究期间FO与谵妄/昏迷天数（DCDs）之间的关联。
结果
共纳入118例患者，分为FO组和非FO组。40%的患者出现液体超负荷。FO组的急性生理与慢性健康状况评分系统II（APACHE II）评分高于非FO组（19[16 - 26]对23[20 - 29]，P = 0.017）。FO组第3天的累积液体平衡更高（3238[281 - 6530]对7886[4106 - 10631]，P < 0.001）。FO组7天内的谵妄天数更长（1[0 - 3]对2[1 - 3]，P = 0.048），DCDs也更长（4[1 - 5]对6[3 - 7]，P = 0.002）。在对协变量进行调整后，FO与DCDs之间存在显著关联（优势比，2.16；95%置信区间，1.05 - 4.47）。
结论
我们的研究结果表明，FO与机械通气患者DCDs增加有关。
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