亚洲重症监护病房合理液体治疗的前瞻性观察研究：液体治疗中的另一块拼图

A Prospective Observational Study of Rational Fluid Therapy in Asian Intensive Care Units: Another Puzzle Piece in Fluid Therapy.

作者信息

Jacob Matthias, Sahu Sambit, Singh Yogendra P, Mehta Yatin, Yang Kuang-Yao, Kuo Shuenn-Wen, Memom Farooq, Prayag Shirish, Pande Rajesh, Jaiswal Nirmal, Cheng Tan C, Mandal Amit, Deva Shanti R, Mathew Mohan, Ramakrishnan Nagarajan, Rai Vineya, Wah Luah, Ramachandran Gopinath, Chawla Rajesh, Khan Z A, Divatia J V, Mishra Rajesh, Amin Pravin, Shelgaokar Jayant, Zwissler Bernhard, Van Aken Hugo, Ertmer Christian

机构信息

Department of Anesthesiology and Surgical Intensive Care, St. Elisabeth Hospital, Straubing, Germany.

Krishna Institute of Medical Science, Secunderabad, Andhra Pradesh, India.

出版信息

Indian J Crit Care Med. 2020 Nov;24(11):1028-1036. doi: 10.5005/jp-journals-10071-23653.

DOI:10.5005/jp-journals-10071-23653

PMID:33384507

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7751049/

Abstract

INTRODUCTION

Fluid therapy in critically ill patients, especially timing and fluid choice, is controversial. Previous randomized trials produced conflicting results. This observational study evaluated the effect of colloid use on 90-day mortality and acute kidney injury (RIFLE F) within the Rational Fluid Therapy in Asia (RaFTA) registry in intensive care units.

MATERIALS AND METHODS

RaFTA is a prospective, observational study in Asian intensive care unit (ICU) patients focusing on fluid therapy and related outcomes. Logistic regression was performed to identify risk factors for increased 90-day mortality and acute kidney injury (AKI).

RESULTS

Twenty-four study centers joined the RaFTA registry and collected 3,187 patient data sets from November 2011 to September 2012. A follow-up was done 90 days after ICU admission. For 90-day mortality, significant risk factors in the overall population were sepsis at admission (OR 2.185 [1.799; 2.654], < 0.001), cumulative fluid balance (OR 1.032 [1.018; 1.047], < 0.001), and the use of vasopressors (OR 3.409 [2.694; 4.312], < 0.001). The use of colloids was associated with a reduced risk of 90-day mortality (OR 0.655 [0.478; 0.900], = 0.009). The initial colloid dose was not associated with an increased risk for AKI (OR 1.094 [0.754; 1.588], = 0.635).

CONCLUSION

RaFTA adds the important finding that colloid use was not associated with increased 90-day mortality or AKI after adjustment for baseline patient condition.

CLINICAL SIGNIFICANCE

Early resuscitation with colloids showed potential mortality benefit in the present analysis. Elucidating these findings may be an approach for future research.

HOW TO CITE THIS ARTICLE

Jacob M, Sahu S, Singh YP, Mehta Y, Yang K-Y, Kuo S-W, A Prospective Observational Study of Rational Fluid Therapy in Asian Intensive Care Units: Another Puzzle Piece in Fluid Therapy. Indian J Crit Care Med 2020;24(11):1028-1036.

摘要

引言

危重症患者的液体治疗，尤其是时机和液体选择，存在争议。以往的随机试验产生了相互矛盾的结果。这项观察性研究在亚洲重症监护病房的合理液体治疗（RaFTA）登记处评估了胶体使用对90天死亡率和急性肾损伤（RIFLE F）的影响。

材料与方法

RaFTA是一项针对亚洲重症监护病房（ICU）患者的前瞻性观察性研究，重点关注液体治疗及相关结果。进行逻辑回归以确定90天死亡率增加和急性肾损伤（AKI）的危险因素。

结果

24个研究中心加入了RaFTA登记处，并在2011年11月至2012年9月期间收集了3187例患者的数据集。在ICU入院90天后进行随访。对于90天死亡率，总体人群中的显著危险因素为入院时的脓毒症（比值比2.185 [1.799；2.654]，P<0.001）、累积液体平衡（比值比1.032 [1.018；1.047]，P<0.001）以及血管升压药的使用（比值比3.409 [2.694；4.312]，P<0.001）。胶体的使用与90天死亡率风险降低相关（比值比0.655 [0.478；0.900]，P = 0.009）。初始胶体剂量与AKI风险增加无关（比值比1.094 [0.754；1.588]，P = 0.635）。