平衡溶液与脓毒症儿童液体复苏期间急性肾损伤的关系。

Association Between Unbalanced Solutions and Acute Kidney Injury During Fluid Resuscitation in Children With Sepsis.

机构信息

Department of Pediatrics and Intensive Care, Universidad de la Sabana, 42705Fundación Cardioinfantil-Instituto de Cardiología, Universidad CES Graduate School, Bogotá, Colombia.

Department of Pediatrics and Intensive Care, 42705Fundación Cardioinfanti-Instituto de Cardiología, Universidad el Rosario, Bogotá, Colombia.

出版信息

J Intensive Care Med. 2022 May;37(5):625-632. doi: 10.1177/08850666211004453. Epub 2021 Apr 29.

DOI:10.1177/08850666211004453

PMID:33926299

Abstract

OBJECTIVE

To evaluate the outcomes of patients with sepsis-associated organ dysfunction and septic shock who receive fluid resuscitation with balanced and unbalanced solutions in a middle-income country.

DESIGN

An observational, analytical cohort study with propensity score matching (PSM) in children admitted to a pediatric intensive care unit (PICU). Patients from one month to 17 years old who required fluid boluses due to hemodynamic instability were included. The primary outcome was the presence of acute kidney injury and the secondary outcomes were the need to begin continuous renal replacement therapy (CRRT), metabolic acidosis, PICU length of stay and mortality.

MEASUREMENTS AND MAIN RESULTS

Out of the 1,074 admissions to the PICU during the study period, 99 patients had sepsis-associated organ dysfunction and septic shock. Propensity score matching was performed including each patient´s baseline characteristics. The median age was 9.9 months (IQR 4.9-22.2) with 55.5% of the patients being male. Acute kidney injury was seen less frequently in children who received a balanced solution than in those who received an unbalanced solution (20.3% vs 25.7% = 0.006 ORa, 0.75; 95% CI, 0.65-0.87), adjusted for disease severity. In addition, the group that received balanced solutions had less need for CRRT (3.3 % vs 6.5%; = 0.02 ORa 0.48; 95% CI, 0.36-0.64) and a shorter PICU stay (6 days IQR 4.4-20.2 vs 10.2 days IQR 4.7-26; < 0.001) than the group with unbalanced solutions. We found no difference in the frequency of metabolic acidosis ( = 0.37), hyperchloremia ( = 0.11) and mortality ( = 0.25) between the 2 groups.

CONCLUSION

In children with sepsis-associated organ dysfunction and septic shock, the use of unbalanced solutions for fluid resuscitation is associated with a higher frequency of acute kidney injury, a greater need for continuous renal support and a longer PICU stay compared to the use of balanced solutions, in a middle-income country.

摘要

目的

评估在中低收入国家中，接受平衡和非平衡溶液复苏的脓毒症相关器官功能障碍和脓毒性休克患者的结局。

设计

一项在儿科重症监护病房（PICU）中接受观察性、分析性队列研究，并进行倾向评分匹配（PSM）。纳入因血流动力学不稳定而需要液体冲击的 1 个月至 17 岁的患儿。主要结局为急性肾损伤的发生，次要结局为开始连续性肾脏替代治疗（CRRT）、代谢性酸中毒、PICU 住院时间和死亡率。

测量和主要结果

在研究期间，1074 例 PICU 入院患者中，99 例患儿患有脓毒症相关器官功能障碍和脓毒性休克。进行了倾向评分匹配，包括每个患者的基线特征。中位年龄为 9.9 个月（IQR 4.9-22.2），55.5%的患儿为男性。接受平衡溶液的患儿发生急性肾损伤的频率低于接受非平衡溶液的患儿（20.3%比 25.7%，比值比（ORa）为 0.75；95%CI，0.65-0.87），调整了疾病严重程度。此外，接受平衡溶液的患儿更不需要 CRRT（3.3%比 6.5%，比值比（ORa）为 0.48；95%CI，0.36-0.64），且 PICU 住院时间更短（6 天 IQR 4.4-20.2 比 10.2 天 IQR 4.7-26；<0.001）。两组之间代谢性酸中毒（比值比（ORa）为 0.37）、高氯血症（比值比（ORa）为 0.11）和死亡率（比值比（ORa）为 0.25）的发生率无差异。