Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197, Rui Jin Er Road, Shanghai, China.
Shanghai Jiao Tong University School of Nursing, Shanghai, China.
Crit Care. 2023 Mar 18;27(1):114. doi: 10.1186/s13054-023-04403-y.
Although subcutaneous edema is a common symptom of critically ill patients, it is still underreported due to the lack of a systematic method for evaluating it. The present study aims to describe the occurrence and distribution of subcutaneous edema, as well as the risk factors associated with it, in critically ill patients using the focused liquid ultrasonography in dropsy (FLUID) protocol, and to assess their impact on ICU mortality.
The FLUID protocol and the pitting test were performed on general ICU patients in China. Cohen's Kappa coefficient and Bland-Altman plots were used to evaluate the agreement between the two methods at each measurement site and between the whole-body subcutaneous edema scores, respectively, while a repeated measures ANOVA was performed to compare the differences between the two methods in whole-body and body-part measurements. A generalized linear model was used to evaluate the risk factors for subcutaneous edema development and the relationship between subcutaneous edema severity and ICU mortality.
A total of 145 critically ill patients were evaluated using both approaches, of whom 40 (27.6%) experienced subcutaneous edema. Over 1440 measurements, it was found that ultrasound discovered more subcutaneous edema than the pitting test (ultrasound: 522[36.3%], pitting test: 444[30.8%], χ = 9.477, p = 0.002). The FLUID protocol scored edema severity significantly higher than the pitting test in the whole body and specific body parts, including the abdominal wall, thighs, chest wall, and hands. Subcutaneous edema exhibited gravity-dependent distribution patterns, particularly in the abdominal wall. The APACHE II, NT-proBNP, serum creatinine, and sepsis were independent risk factors for subcutaneous edema development. The score of ultrasonic subcutaneous edema was related to ICU mortality.
The FLUID protocol provides a comprehensive strategy for the semi-quantitative assessment of subcutaneous edema in critically ill patients. In detecting the onset and severity of edema, ultrasound was found to outperform the pitting test. Subcutaneous edema showed a gravity-dependent distribution pattern, and its severity was associated with mortality.
尽管皮下水肿是危重症患者的常见症状，但由于缺乏系统的评估方法，其仍未得到充分报告。本研究旨在使用聚焦液体超声水肿（FLUID）方案描述危重症患者皮下水肿的发生和分布情况，以及与其相关的危险因素，并评估其对 ICU 死亡率的影响。
在中国的普通 ICU 患者中进行了 FLUID 方案和凹陷试验。使用 Cohen's Kappa 系数和 Bland-Altman 图分别评估两种方法在每个测量部位和全身皮下水肿评分之间的一致性，同时使用重复测量方差分析比较两种方法在全身和身体部位测量之间的差异。使用广义线性模型评估皮下水肿发生的危险因素以及皮下水肿严重程度与 ICU 死亡率之间的关系。
共有 145 名危重症患者同时接受了两种方法的评估，其中 40 名（27.6%）患者发生了皮下水肿。在超过 1440 次测量中，超声发现的皮下水肿多于凹陷试验（超声：522[36.3%]，凹陷试验：444[30.8%]，χ²=9.477，p=0.002）。FLUID 方案在全身和特定身体部位（包括腹壁、大腿、胸壁和手部）的水肿严重程度评分显著高于凹陷试验。皮下水肿呈重力依赖性分布模式，尤其是在腹壁。APACHE II、NT-proBNP、血清肌酐和脓毒症是皮下水肿发生的独立危险因素。超声皮下水肿评分与 ICU 死亡率相关。
FLUID 方案为危重症患者皮下水肿的半定量评估提供了一种全面的策略。在检测水肿的发生和严重程度方面，超声优于凹陷试验。皮下水肿呈重力依赖性分布模式，其严重程度与死亡率相关。
