Department of Surgical Critical Care Medicine, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, China.
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2020 Aug;95(8):1660-1670. doi: 10.1016/j.mayocp.2020.03.029. Epub 2020 Jun 27.
To compare elastic bandage (EB) vs hypertonic albumin solution administration to increase fluid removal by enhancing loop diuretic efficiency (DE) in patients with volume overload and diuretic resistance.
In this historic cohort study with propensity matching, we included diuretic-resistant adult (≥18 years) patients with volume overload after fluid resuscitation admitted in the intensive care unit from January 1, 2006, through June 30, 2017. Regression models and propensity matching were used to assess the associations of these interventions with changes in DE and other clinical outcomes.
Of 1147 patients (median age, 66; interquartile range [IQR], 56-76 years; 51% [n=590] men), 384 (33%) received EB and 763 (67%) received hypertonic albumin solution. In adjusted models, EB was significantly associated with higher DE compared with hypertonic albumin solution (odds ratio, 1.37; 95% CI, 1.04 to 1.81; P=.004). After propensity matching of 345 pairs, DE remained significantly different between the 2 groups (median, 2111; IQR, 1092 to 4665 mL for EB vs median, 1829; IQR, 1032 to 3436 mL for hypertonic albumin solution; P=.02). EB, male sex, lower baseline serum urea nitrogen level, lower Charlson Comorbidity Index score, and higher baseline left ventricular ejection fraction were DE determinants. The lowest DE quartile (<1073 mL/40-mg furosemide equivalent) following adjustment for known predictors of mortality remained independently associated with higher 90-day death rate (odds ratio, 1.64; 95% CI, 1.13 to 2.36; P=.009).
EB use is associated with greater DE than hypertonic albumin solution during the deescalation phase of sepsis resuscitation. Prospective clinical trials would validate the findings of this hypothesis-generating study.
比较弹性绷带（EB）与高渗白蛋白溶液给药，通过增强襻利尿剂效率（DE）以增加液体清除率，从而治疗容量超负荷和利尿剂抵抗患者。
这是一项历史性队列研究，采用倾向匹配，纳入了 2006 年 1 月 1 日至 2017 年 6 月 30 日期间在重症监护病房因液体复苏后发生容量超负荷而接受治疗的成年（≥18 岁）利尿剂抵抗患者。回归模型和倾向匹配用于评估这些干预措施与 DE 变化和其他临床结局的相关性。
在 1147 例患者中（中位数年龄 66 岁，四分位距 [IQR] 56-76 岁；51%[n=590]为男性），384 例（33%）接受 EB 治疗，763 例（67%）接受高渗白蛋白溶液治疗。在调整后的模型中，EB 与高渗白蛋白溶液相比，DE 显著更高（比值比，1.37；95%置信区间，1.04 至 1.81；P=0.004）。经过 345 对的倾向匹配后，两组间 DE 仍存在显著差异（中位数，2111；IQR，1092 至 4665 mL 比 EB，中位数，1829；IQR，1032 至 3436 mL；P=0.02）。EB、男性、较低的基线血清尿素氮水平、较低的 Charlson 合并症指数评分和较高的基线左心室射血分数是 DE 的决定因素。在调整已知死亡率预测因素后，DE 的最低四分位数（＜1073 mL/40-mg 呋塞米当量）仍与 90 天死亡率较高独立相关（比值比，1.64；95%置信区间，1.13 至 2.36；P=0.009）。
在脓毒症复苏的降级阶段，与高渗白蛋白溶液相比，EB 治疗与更大的 DE 相关。前瞻性临床试验将验证这项假设生成研究的结果。
