Department of Intensive Care, University Medical Center Groningen, Groningen, The Netherlands.
Research Group Nursing Diagnostics, Hanze University of Applied Sciences, Groningen, The Netherlands.
PLoS One. 2024 Apr 26;19(4):e0299474. doi: 10.1371/journal.pone.0299474. eCollection 2024.
The fluid balance is a critical parameter in intensive care units (ICU) as it provides information about the patient's volume status. However, the accuracy of fluid balance measurements is often compromised due to the complexity and repetition of actions involved. Additionally, the fluid balance could be recalculated for insensible fluid loss. Weighing is an alternative method to estimate the patient's volume status. Built-in scales in beds make patient weighing easier and less time-consuming, allowing clinicians to intervene more quickly on existing treatments.
This study compares fluid balance, and body weight changes over time in ICU patients. Furthermore, it seeks to determine the degree of congruence between the fluid balance corrected for insensible fluid loss and daily body weight in ICU patients.
A single-center observational study was conducted in an ICU of a university hospital. All consecutive patients admitted to a bed with an integrated weighing scale were eligible. Exclusion criteria were (1) body weight ≥254,4 kilograms; (2) oral nutrition; (3) a flush catheter or balance; (4) only a single weight measurement; (5) delta body weight change of ≥5kg in 12 hours. Weights and fluid balances were obtained every 12 hours.
We obtained 2282 measurements (n = 187 patients). The correlation between weight and fluid balance was weak (r = 0.274). After adjusting the fluid balance for insensible fluid loss, the correlation remained weak (r = 0,268). Bland Altman analysis revealed a wide confidence interval for both the fluid balance and corrected fluid balance versus weight.
This study shows a weak correlation between weight and fluid balance. Therefore, when monitoring the volume status in the ICU, fluid balance and weight should both be taken into account. This two-pronged approach is crucial because it provides more control over erroneous fluid balance or weighing measurements.
在重症监护病房（ICU）中，液体平衡是一个关键参数，因为它提供了有关患者容量状态的信息。然而，由于涉及的操作复杂且重复，液体平衡测量的准确性经常受到影响。此外，还可以重新计算不可感知的液体丢失量来计算液体平衡。称重是一种替代方法，可以估计患者的容量状态。床内置的秤使患者称重变得更容易且耗时更少，从而使临床医生能够更快地对现有治疗进行干预。
本研究比较了 ICU 患者的液体平衡和随时间变化的体重变化。此外，还旨在确定 ICU 患者不可感知的液体丢失校正后的液体平衡与每日体重之间的一致性程度。
这是一项在大学附属医院 ICU 进行的单中心观察性研究。所有符合条件的患者均为入住内置称重秤的病床。排除标准为：（1）体重≥254.4 千克；（2）口服营养；（3）冲洗导管或平衡；（4）仅有一次体重测量；（5）12 小时内体重变化≥5kg。每 12 小时测量一次体重和液体平衡。
共获得 2282 次测量值（n=187 名患者）。体重与液体平衡之间的相关性较弱（r=0.274）。在对不可感知的液体丢失进行液体平衡校正后，相关性仍然较弱（r=0.268）。Bland-Altman 分析显示，液体平衡和校正后的液体平衡与体重的置信区间均较宽。
本研究显示体重与液体平衡之间的相关性较弱。因此，在 ICU 监测容量状态时，应同时考虑液体平衡和体重。这种双管齐下的方法至关重要，因为它可以更好地控制错误的液体平衡或称重测量。
