Koc Vildan, Delmas Benito Laura, de With Eldert, Boerma E Christiaan
Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, Netherlands.
Crit Care Res Pract. 2020 Dec 4;2020:4836862. doi: 10.1155/2020/4836862. eCollection 2020.
Although the detrimental effects of excessive perioperative fluid administration are generally well established, data in the setting of cardiac surgery remain less robust.
In this retrospective single-center observational study, the total fluid balance in the first 12 hours during and after surgery was evaluated. Primary endpoint was the relationship between total fluid balance and the incidence of prolonged mechanical ventilation. For this purpose, data were divided into quartiles (Q); prolonged mechanical ventilation and prolonged length of stay (LOS) in the ICU were defined as Q4. Secondary endpoints were prolonged LOS in the ICU, incidence of acute kidney injury (AKI; defined as a 1.5-fold increase in serum creatinine during, relative to baseline), and ICU mortality.
In a 3-year period, 748 patients were included. In a univariate analysis, the median duration of mechanical ventilation was 2.9 h [2.4-3.7] in Q1 of the fluid balance and increased significantly to 4.7 h [3.1-9.2] in Q4 of the fluid balance ( < 0.001). In addition, patients in Q4 of the fluid balance had a significantly longer LOS in the ICU, as well as a higher incidence of AKI and ICU mortality. In a multivariate analysis, Q4 of the fluid balance was independently associated with prolonged mechanical ventilation (OR 4.9, CI 2.9-8.4, < 0.001) and prolonged LOS in the ICU (OR 11.3 CI 6.1-20,9, < 0.001), but not with the incidence of AKI or ICU mortality.
Perioperative fluid administration in cardiac surgery patients was independently associated with prolonged mechanical ventilation and prolonged LOS in the ICU.
尽管围手术期液体过量输注的有害影响已基本明确，但心脏手术方面的数据仍不充分。
在这项回顾性单中心观察性研究中，评估了手术期间及术后12小时内的总液体平衡情况。主要终点是总液体平衡与机械通气时间延长发生率之间的关系。为此，将数据分为四分位数（Q）；机械通气时间延长和重症监护病房（ICU）住院时间延长定义为Q4。次要终点包括ICU住院时间延长、急性肾损伤（AKI；定义为与基线相比，血清肌酐在术中升高1.5倍）发生率及ICU死亡率。
在3年期间，共纳入748例患者。单因素分析显示，液体平衡Q1组的机械通气中位时间为2.9小时[2.4 - 3.7]，而液体平衡Q4组显著增至4.7小时[3.1 - 9.2]（P < 0.001）。此外，液体平衡Q4组患者的ICU住院时间显著更长，AKI发生率及ICU死亡率也更高。多因素分析显示，液体平衡Q4与机械通气时间延长（比值比4.9，95%置信区间2.9 - 8.4，P < 0.001）及ICU住院时间延长（比值比11.3，95%置信区间（6.1 - 20.9），P < 0.001）独立相关，但与AKI发生率或ICU死亡率无关。
心脏手术患者围手术期液体输注与机械通气时间延长及ICU住院时间延长独立相关。
