Alharbi Reham A, Aldardeer Namareq F, Heaphy Emily L G, Alabbasi Ahmad H, Albuqami Amjad M, Hawa Hassan
Division of Pharmaceutical Care, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Department of Research, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Acute Crit Care. 2023 May;38(2):209-216. doi: 10.4266/acc.2022.01550. Epub 2023 May 16.
Percent fluid overload greater than 5% is associated with increased mortality. The appropriate time for fluid deresuscitation depends on the patient's radiological and clinical findings. This study aimed to assess the applicability of percent fluid overload calculations for evaluating the need for fluid deresuscitation in critically ill patients.
This was a single-center, prospective, observational study of critically ill adult patients requiring intravenous fluid administration. The study's primary outcome was median percent fluid accumulation on the day of fluid deresuscitation or intensive care unit (ICU) discharge, whichever came first.
A total of 388 patients was screened between August 1, 2021, and April 30, 2022. Of these, 100 with a mean age of 59.8±16.2 years were included for analysis. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 15.4±8.0. Sixty-one patients (61.0%) required fluid deresuscitation during their ICU stay, while 39 (39.0%) did not. Median percent fluid accumulation on the day of deresuscitation or ICU discharge was 4.5% (interquartile range [IQR], 1.7%-9.1%) and 5.2% (IQR, 2.9%-7.7%) in patients requiring deresuscitation and those who did not, respectively. Hospital mortality occurred in 25 (40.9%) of patients with deresuscitation and six (15.3%) patients who did not require it (P=0.007).
The percent fluid accumulation on the day of fluid deresuscitation or ICU discharge was not statistically different between patients who required fluid deresuscitation and those who did not. A larger sample size is needed to confirm these findings.
液体超负荷超过5%与死亡率增加相关。液体复苏的合适时机取决于患者的影像学和临床检查结果。本研究旨在评估液体超负荷百分比计算在评估重症患者液体复苏需求中的适用性。
这是一项针对需要静脉输液的成年重症患者的单中心、前瞻性观察性研究。该研究的主要结局是液体复苏当天或重症监护病房（ICU）出院当天（以先到者为准）的液体累积中位数百分比。
在2021年8月1日至2022年4月30日期间共筛查了388例患者。其中，100例平均年龄为59.8±16.2岁的患者纳入分析。急性生理与慢性健康状况评分系统（APACHE）II平均评分为15.4±8.0。61例患者（61.0%）在ICU住院期间需要进行液体复苏，而39例（39.0%）不需要。需要液体复苏的患者和不需要液体复苏的患者在液体复苏当天或ICU出院当天的液体累积中位数百分比分别为4.5%（四分位间距[IQR]，1.7%-9.1%）和5.2%（IQR，2.9%-7.7%）。进行液体复苏的患者中有25例（40.9%）发生医院死亡，未进行液体复苏的患者中有6例（15.3%）发生医院死亡（P=0.007）。
需要液体复苏的患者和不需要液体复苏的患者在液体复苏当天或ICU出院当天的液体累积百分比无统计学差异。需要更大样本量来证实这些发现。
