Faltys Martin, Neto Ary Serpa, Cioccari Luca
Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Intensive Care, Austin Hospital, Melbourne, Australia.
Crit Care Resusc. 2024 Jan 12;26(1):32-40. doi: 10.1016/j.ccrj.2023.11.005. eCollection 2024 Mar.
Fluid bolus therapy (FBT) is ubiquitous in intensive care units (ICUs) after cardiac surgery. However, its physiological effects remain unclear.
We performed an electronic health record-based quasi-experimental ICU study after cardiac surgery. We applied propensity score matching and compared the physiological changes after FBT episodes to matched control episodes where despite equivalent physiology no fluid bolus was given.
The study was conducted in a multidisciplinary ICU of a tertiary-level academic hospital.
The study included 2,736 patients who underwent Coronary Artery Bypass Grafting and/or heart valve surgery.
Changes in cardiac output (CO) and mean arterial pressure (MAP) during the 60 minutes following FBT.
We analysed 3572 matched fluid bolus (FB) episodes. After FBT, but not in control episodes, CO increased within 10 min, with a maximum increase of 0.2 l/min (95%CI 0.1 to 0.2) or 4% above baseline at 40 min (p < 0.0001 vs. controls). CO increased by > 10% from baseline in 60.6% of FBT and 49.1% of control episodes (p < 0.0001). MAP increased by > 10% in 51.7% of FB episodes compared to 53.4% of controls. Finally, FBT was not associated with changes in acid-base status or oxygen delivery.
In this quasi-experimental comparative ICU study in cardiac surgery patients, FBT was associated with statistically significant but numerically small increases in CO. Nearly half of FBT failed to induce a positive CO or MAP response.
液体冲击疗法（FBT）在心脏手术后的重症监护病房（ICU）中广泛应用。然而，其生理效应仍不明确。
我们开展了一项基于电子健康记录的心脏手术后ICU准实验研究。我们应用倾向得分匹配法，将FBT期间的生理变化与匹配的对照期间进行比较，在对照期间，尽管生理状态相同，但未给予液体冲击。
该研究在一家三级学术医院的多学科ICU中进行。
该研究纳入了2736例行冠状动脉旁路移植术和/或心脏瓣膜手术的患者。
FBT后60分钟内心输出量（CO）和平均动脉压（MAP）的变化。
我们分析了3572次匹配的液体冲击（FB）事件。FBT后，但对照期间未出现，CO在10分钟内增加，最大增加量为0.2升/分钟（95%CI 0.1至0.2），或在40分钟时比基线水平高出4%（与对照组相比，p<0.0001）。在60.6%的FBT事件和49.1%的对照事件中，CO较基线水平增加>10%（p<0.0001）。与53.4%的对照组相比，51.7%的FB事件中MAP增加>10%。最后，FBT与酸碱状态或氧输送的变化无关。
在这项针对心脏手术患者的准实验性比较ICU研究中，FBT与CO在统计学上有显著但数值较小的增加相关。近一半的FBT未能诱导出积极的CO或MAP反应。
