Critical Care Pharmacy Specialist, Baltimore, Maryland, USA.
Smiths Medical ASD, Inc, Minneapolis, MN, USA.
Ann Pharmacother. 2022 Jan;56(1):35-43. doi: 10.1177/10600280211013581. Epub 2021 May 5.
Positive fluid balance early in critical illness is associated with poor outcomes. Reducing intravenous medication volume may mitigate volume overload. Assessment of fluid and medication administration and clinical outcomes in acute respiratory failure.
Single-center, prospective observational study of hemodynamically stable adult patients in a medical intensive care unit (MICU) with acute respiratory failure.
Median cumulative total intake volume was 12 890 (interquartile range [IQR] = 8654-22 221) mL (n = 27), and median cumulative intravenous medication volume was 3563 (IQR = 2371-9412) mL over the first 7 days. Medication volume accounted for 27.6% of aggregate fluid volume. Median daily intravenous medication volume administered was 591 (IQR = 339-1082) mL. Cumulative fluid volume was associated with reduced ventilator-free days ( = -0.393; = 0.043), and cumulative fluid volumes during the first 3 and 7 days were associated with increased MICU length of stay (LOS ± standard error 0.73 ± 0.35 d/L, = 0.047, and 0.38 ± 0.16 d/L, = 0.021, respectively). Cumulative medication volume administered significantly reduced the likelihood of mechanical ventilator liberation (hazard ratio [HR] = 0.917; 95% CI: 0.854, 0.984; = 0.016) and MICU discharge (HR = 0.911; 95% CI: 0.843, 0.985; = 0.019). Small-volume infusion may decrease cumulative intravenous medication volume by 38%.
Intravenous medication diluent contributes substantially to total fluid intake in patients with acute respiratory failure and is associated with poor outcomes. Reduction of intravenous medication fluid volume to improve clinical outcomes should be further investigated.
危重病早期的正液体平衡与不良结局相关。减少静脉用药量可能会减轻容量超负荷。评估急性呼吸衰竭患者的液体和药物管理及临床结局。
对血流动力学稳定的急性呼吸衰竭成年患者进行单中心前瞻性观察性研究，患者入组于医疗重症监护病房（MICU）。
在第 1 天至第 7 天期间，中位累积总摄入液体量为 12890（四分位距[IQR] = 8654-22221）mL（n = 27），累积静脉用药量为 3563（IQR = 2371-9412）mL。用药量占总液体量的 27.6%。中位每日静脉用药量为 591（IQR = 339-1082）mL。累积液体量与无机械通气天数减少相关（β = -0.393；P = 0.043），前 3 天和前 7 天的累积液体量与 MICU 住院时间延长相关（每增加 1L，MICU LOS 分别增加 ± 标准误差 0.73 ± 0.35 d/L，P = 0.047，和 0.38 ± 0.16 d/L，P = 0.021）。累积静脉用药量减少显著降低了机械通气脱机的可能性（风险比[HR] = 0.917；95%置信区间：0.854，0.984；P = 0.016）和 MICU 出院（HR = 0.911；95%置信区间：0.843，0.985；P = 0.019）。小容量输液可能会使累积静脉用药量减少 38%。
静脉用药稀释剂在急性呼吸衰竭患者中大量摄入液体，与不良结局相关。减少静脉用药液量以改善临床结局应进一步研究。
