Matsuda Wataru, Funato Yumi, Miyazaki Momoyo, Tomiyama Koichiro
Department of Emergency Medicine and Critical Care Center Hospital of the National Center for Global Health and Medicine Toyama, Shinjuku, Tokyo Japan.
Acute Med Surg. 2022 Sep 30;9(1):e795. doi: 10.1002/ams2.795. eCollection 2022 Jan-Dec.
Administration of at least 30 mL/kg of fluid as fluid resuscitation is recommended for patients with sepsis and signs of hypoperfusion. However, it is not clear whether this is appropriate for patients with a do-not-intubate (DNI) order. This study evaluated the association between volume of fluid resuscitation and outcomes in patients with infection, signs of hypoperfusion, and a DNI order in an emergency department.
This was a single-center retrospective cohort study. We classified the infected patients with signs of hypoperfusion and a DNI order seen in our emergency department between April 1, 2015 and November 31, 2020 into the standard fluid resuscitation group (≥30 mL/kg) and the restricted fluid resuscitation group (<30 mL/kg). We compared with in-hospital mortality and the rate of discharge to home in two groups.
Of 367 patients, 149 received standard fluid resuscitation and 218 received restricted fluid resuscitation. In-hospital mortality was similar in each group (40/149 and 62/218, respectively). Standard fluid resuscitation was not associated with in-hospital mortality (adjusted odds ratio [aOR], 1.05; 95% confidence interval [CI], 0.62-1.77, = 0.86), but was associated with a significantly lower rate of discharge to home (aOR, 0.55; 95% CI, 0.30-0.98, = 0.043). There was no significant difference in respiratory rate or need for oxygen therapy post-resuscitation between the two groups.
This study suggests that fluid resuscitation may be not beneficial for infected patients with signs of hypoperfusion and a DNI order. Further studies should be conducted on the options for resuscitation management for these patients.
对于患有脓毒症且有灌注不足体征的患者，建议进行至少30毫升/千克的液体复苏治疗。然而，对于有不插管（DNI）医嘱的患者，这样做是否合适尚不清楚。本研究评估了急诊科中感染、有灌注不足体征且有DNI医嘱的患者液体复苏量与预后之间的关联。
这是一项单中心回顾性队列研究。我们将2015年4月1日至2020年11月31日期间在我们急诊科就诊的有灌注不足体征且有DNI医嘱的感染患者分为标准液体复苏组（≥30毫升/千克）和限制性液体复苏组（<30毫升/千克）。我们比较了两组的院内死亡率和回家出院率。
367例患者中，149例接受了标准液体复苏，218例接受了限制性液体复苏。每组的院内死亡率相似（分别为40/149和62/218）。标准液体复苏与院内死亡率无关（调整后的优势比[aOR]，1.05；95%置信区间[CI]，0.62 - 1.77，P = 0.86），但与回家出院率显著降低相关（aOR，0.55；95%CI，0.30 - 0.98，P = 0.043）。两组复苏后呼吸频率或吸氧需求无显著差异。
本研究表明，液体复苏可能对有灌注不足体征且有DNI医嘱的感染患者无益。应针对这些患者的复苏管理选项开展进一步研究。
