稳定瑞典 ICU 患者液体、钠和钾的隐性来源：一项多中心回顾性观察研究。

Hidden sources of fluids, sodium and potassium in stabilised Swedish ICU patients: A multicentre retrospective observational study.

机构信息

From the Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University Hospital, Uppsala (SN, RK, AB, ML), Department of Anesthesiology and Intensive Care, Gävle County Hospital, Gävle (JR), Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg (CR), Centre for Clinical Research Sörmland, Uppsala University, Uppsala (AP), Perioperative Medicine and Intensive Care, Karolinska University Hospital and FyFa, Karolinska Institutet, Stockholm (MC) and Hedenstierna Laboratory, CIRRUS, Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University Hospital, Uppsala, Sweden (ML).

出版信息

Eur J Anaesthesiol. 2021 Jun 1;38(6):625-633. doi: 10.1097/EJA.0000000000001354.

DOI:10.1097/EJA.0000000000001354

PMID:33074941

Abstract

BACKGROUND

Fluid overload in ICU patients is associated with increased morbidity and mortality. Although studies report on optimisation of resuscitation fluids given to ICU patients, increasing evidence suggests that maintenance fluids and fluids used to administer drugs are important sources of fluid overload.

OBJECTIVES

We aimed to evaluate the volume of maintenance fluids and electrolytes on overall fluid balance and their relation to mortality in stabilised ICU patients.

DESIGN

Multicentre retrospective observational study.

SETTING

Six mixed surgical and medical ICUs in Sweden.

PATIENTS

A total of 241 adult patients who spent at least 7 days in the ICU during 2018.

MAIN OUTCOME MEASURES

The primary endpoint was the volume of maintenance, resuscitation and drug diluent fluids administered on days 3 to 7 in the ICU. Secondary endpoints were to compare dispensed amounts of maintenance fluids and electrolytes with predicted requirements. We also investigated the effects of administered fluids and electrolytes on patient outcomes.

RESULTS

During ICU days 3 to 7, 56.4% of the total fluids given were maintenance fluids, nutritional fluids or both, 25.4% were drug fluids and 18.1% were resuscitation fluids. Patients received fluids 1.29 (95% confidence interval 1.07 to 1.56) times their estimated fluid needs. Despite this, 93% of the cohort was treated with diuretics or renal replacement therapy. Patients were given 2.17 (1.57 to 2.96) times their theoretical sodium needs and 1.22 (0.75 to 1.77) times their potassium needs. The median [IQR] volume of fluid loss during the 5-day study period was 3742 [3156 to 4479] ml day-1, with urine output the main source of fluid loss. Death at 90 days was not associated with fluid or electrolyte balance in this cohort.

CONCLUSION

Maintenance and drug fluids far exceeded resuscitative fluids in ICU patients beyond the resuscitative phase. This excess fluid intake, in conjunction with high urinary output and treatment for fluid offload in almost all patients, suggests that a large volume of the maintenance fluids given was unnecessary.

TRIAL REGISTRATION

ClinicalTrials.org NCT03972475.

摘要

背景

ICU 患者液体超负荷与发病率和死亡率增加有关。尽管有研究报告了 ICU 患者复苏液的优化，但越来越多的证据表明，维持液和用于给药的液体是液体超负荷的重要来源。

目的

我们旨在评估 ICU 稳定患者的维持液量和电解质对总体液体平衡的影响及其与死亡率的关系。

设计

多中心回顾性观察性研究。

地点

瑞典六家混合外科和内科 ICU。

患者

2018 年至少在 ICU 中度过 7 天的 241 名成年患者。

主要观察指标

主要终点是 ICU 第 3 至 7 天期间给予的维持、复苏和药物稀释液的量。次要终点是比较给予的维持液量和电解质与预测需求的差异。我们还研究了给予的液体和电解质对患者结局的影响。

结果

在 ICU 第 3 至 7 天期间，56.4%的总液体为维持液、营养液或两者兼有，25.4%为药物液，18.1%为复苏液。患者接受的液体量是其估计液体需求的 1.29 倍（95%置信区间 1.07 至 1.56）。尽管如此，93%的患者接受了利尿剂或肾脏替代治疗。患者接受的钠量是其理论需要量的 2.17 倍（1.57 至 2.96），钾量是其理论需要量的 1.22 倍（0.75 至 1.77）。在 5 天的研究期间，液体损失的中位数[IQR]为 3742[3156 至 4479]ml/天，尿液是液体损失的主要来源。在该队列中，90 天死亡率与液体或电解质平衡无关。