Branan Trisha, Smith Susan E, Newsome Andrea Sikora, Phan Rebecca, Hawkins W Anthony
Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA, USA.
Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA, USA.
SAGE Open Med. 2020 Dec 9;8:2050312120979464. doi: 10.1177/2050312120979464. eCollection 2020.
Fluid overload is associated with poor outcomes, but mitigating its occurrence poses significant challenges.
This study sought to assess the impact of hidden fluid volume on fluid overload.
This study was a multi-center, retrospective evaluation of adults admitted to a medical or surgical intensive care unit for at least 72 h. Patients were divided into tertiles (low, moderate, and high) based on the hidden fluid volume received. Hidden fluids were defined as intravenous medications, line flushes, blood products, and enteral nutrition. The primary outcome was the incidence of fluid overload at intensive care unit (day 3). Secondary outcomes included mechanical-ventilation free days and association of hidden fluid volume with fluid overload, length of stay, and mortality.
A total of 219 (73 per tertile) were included, with hidden fluid volume comprising ⩽2500, 2501-4400, and >4400 mL in the low, moderate, and high tertiles, respectively. Incidence of fluid overload was significantly different across groups (low: 3%, moderate: 14%, high: 25%; p < 0.001). No difference existed in mechanical-ventilation free days or in-hospital mortality across tertiles. In binary logistic regression, hidden fluid volume received at 3 days was independently associated with fluid overload (odds ratio = 1.40, 95% confidence interval = 1.15-1.70).
The volume of hidden fluid volume administered by intensive care unit day 3 independently predicted development of fluid overload.
液体超负荷与不良预后相关，但减轻其发生带来了重大挑战。
本研究旨在评估隐匿性液体量对液体超负荷的影响。
本研究是一项对入住内科或外科重症监护病房至少72小时的成年人进行的多中心回顾性评估。根据接受的隐匿性液体量将患者分为三分位数（低、中、高）。隐匿性液体定义为静脉用药、管路冲洗液、血液制品和肠内营养。主要结局是重症监护病房（第3天）液体超负荷的发生率。次要结局包括无机械通气天数以及隐匿性液体量与液体超负荷、住院时间和死亡率的关联。
共纳入219例患者（每个三分位数73例），低、中、高三分位数组的隐匿性液体量分别≤2500、2501 - 4400和>4400 mL。各组间液体超负荷的发生率有显著差异（低：3%，中：14%，高：25%；p<0.001）。三分位数组之间的无机械通气天数或院内死亡率无差异。在二元逻辑回归中，第3天接受的隐匿性液体量与液体超负荷独立相关（比值比 = 1.40，95%置信区间 = 1.15 - 1.70）。
重症监护病房第3天给予的隐匿性液体量独立预测液体超负荷的发生。
