Wrzosek Anna, Drygalski Tomasz, Garlicki Jarosław, Woroń Jarosław, Szpunar Wojciech, Polak Maciej, Droś Jakub, Wordliczek Jerzy, Zajączkowska Renata
Department of Interdisciplinary Intensive Care, Jagiellonian University Medical College, Kraków, Poland.
Department of Anaesthesiology and Intensive Therapy, University Hospital, Kraków, Poland.
Front Med (Lausanne). 2023 Jan 12;9:1040098. doi: 10.3389/fmed.2022.1040098. eCollection 2022.
Appropriate fluid management is essential in the treatment of critically ill trauma patients. Both insufficient and excessive fluid volume can be associated with worse outcomes. Intensive fluid resuscitation is a crucial element of early resuscitation in trauma; however, excessive fluid infusion may lead to fluid accumulation and consequent complications such as pulmonary edema, cardiac failure, impaired bowel function, and delayed wound healing. The aim of this study was to examine the volumes of fluids infused in critically ill trauma patients during the first hours and days of treatment and their relationship to survival and outcomes.
We retrospectively screened records of all consecutive patients admitted to the intensive care unit (ICU) from the beginning of 2019 to the end of 2020. All adults who were admitted to ICU after trauma and were hospitalized for a minimum of 2 days were included in the study. We used multivariate regression analysis models to assess a relationship between volume of infused fluid or fluid balance, age, ISS or APACHE II score, and mortality. We also compared volumes of fluids in survivors and non-survivors including additional analyses in subgroups depending on disease severity (ISS score, APACHE II score), blood loss, and age.
A total of 52 patients met the inclusion criteria for the study. The volume of infused fluids and fluid balance were positively correlated with mortality, complication rate, time on mechanical ventilation, length of stay in the ICU, INR, and APTT. Fluid volumes were significantly higher in non-survivors than in survivors at the end of the second day of ICU stay (2.77 vs. 2.14 ml/kg/h) and non-survivors had a highly positive fluid balance (6.21 compared with 2.48 L in survivors).
In critically ill trauma patients, worse outcomes were associated with higher volumes of infusion fluids and a more positive fluid balance. Although fluid resuscitation is lifesaving, especially in the first hours after trauma, fluid infusion should be limited to a necessary minimum to avoid fluid overload and its negative consequences.
恰当的液体管理对于重症创伤患者的治疗至关重要。液体量不足和过多均可能与更差的预后相关。强化液体复苏是创伤早期复苏的关键要素；然而，过多的液体输注可能导致液体蓄积以及随之而来的并发症，如肺水肿、心力衰竭、肠功能受损和伤口愈合延迟。本研究的目的是检查重症创伤患者在治疗的最初数小时和数天内输注的液体量及其与生存和预后的关系。
我们回顾性筛查了2019年初至2020年底入住重症监护病房（ICU）的所有连续患者的记录。所有创伤后入住ICU且住院至少2天的成年人被纳入研究。我们使用多变量回归分析模型来评估输注液体量或液体平衡、年龄、损伤严重度评分（ISS）或急性生理与慢性健康状况评分系统II（APACHE II）评分与死亡率之间的关系。我们还比较了幸存者和非幸存者的液体量，包括根据疾病严重程度（ISS评分、APACHE II评分）、失血量和年龄在亚组中的额外分析。
共有52例患者符合研究纳入标准。输注液体量和液体平衡与死亡率、并发症发生率、机械通气时间、ICU住院时间、国际标准化比值（INR）和活化部分凝血活酶时间（APTT）呈正相关。在ICU住院第二天结束时，非幸存者的液体量显著高于幸存者（2.77 vs. 2.14 ml/kg/h），且非幸存者的液体平衡为高度正值（6.21 L，而幸存者为2.48 L）。
在重症创伤患者中，更差的预后与更高的输注液体量和更正值的液体平衡相关。尽管液体复苏挽救生命，尤其是在创伤后的最初数小时，但液体输注应限制在必要的最低限度，以避免液体过载及其负面后果。
