脓毒性休克和脓毒症诱发低血压复苏早期的液体冲击量与输注：一家三级医院的回顾性报告及结果分析

Fluid boluses and infusions in the early phase of resuscitation from septic shock and sepsis-induced hypotension: a retrospective report and outcome analysis from a tertiary hospital.

作者信息

Messina Antonio, Albini Marco, Samuelli Nicolò, Brunati Andrea, Costantini Elena, Lionetti Giulia, Lubian Marta, Greco Massimiliano, Matronola Guia Margherita, Piccirillo Fabio, De Backer Daniel, Teboul Jean Louis, Cecconi Maurizio

机构信息

IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.

Department of Biomedical Sciences, Humanitas University, Via Levi Montalcini 4, Pieve Emanuele, Milan, Italy.

出版信息

Ann Intensive Care. 2024 Aug 15;14(1):123. doi: 10.1186/s13613-024-01347-6.

DOI:10.1186/s13613-024-01347-6

PMID:39147957

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11327232/

Abstract

BACKGROUND

Fluid administration is the first line treatment in intensive care unit (ICU) patients with sepsis and septic shock. While fluid boluses administration can be titrated by predicting preload dependency, the amount of other forms of fluids may be more complex to be evaluated. We conducted a retrospective analysis in a tertiary hospital, to assess the ratio between fluids given as boluses and total administered fluid intake during early phases of ICU stay, and to evaluate the impact of fluid strategy on ICU mortality. Data related to fluid administration during the first four days of ICU stay were exported from an electronic health records system (ICCA®, Philips Healthcare). Demographic data, severity score, norepinephrine dose at ICU admission, overall fluid balance and the percentage of different fluid components of the overall volume administered were included in a multivariable logistic regression model, evaluating the association with ICU survival.

RESULTS

We analyzed 220 patients admitted with septic shock and sepsis-induced hypotension from 1st July 2021 to 31st December 2023. Fluid boluses and maintenance represented 49.3% ± 22.8 of the overall fluid intake, being balanced solution the most represented (40.4% ± 22.0). The fluid volume for drug infusion represented 34.0% ± 2.9 of the total fluid intake, while oral or via nasogastric tube fluid intake represented 18.0% ± 15.7 of the total fluid intake. Fluid volume given as boluses represented 8.6% of the total fluid intake over the four days, with a reduction from 25.1% ± 24.0 on Day 1 to 4.8% ± 8.7 on Day 4. A positive fluid balance [OR 1.167 (1.029-1.341); p = 0.021] was the most important factor associated with ICU mortality. Non-survivors (n = 66; 30%) received a higher amount of overall inputs than survivors only on Day 1 [2493 mL vs. 1855 mL; p = 0.022].

CONCLUSIONS

This retrospective analysis of fluids given over the early phases of septic shock and sepsis-induced hypotension showed that the overall volume given by boluses ranges from about 25% on Day 1 to about 5% on Day 4 from ICU admission. Our data confirms that a positive fluid balance over the first 4 days of ICU is associated with mortality.

摘要

背景

对于重症监护病房（ICU）中患有脓毒症和脓毒性休克的患者，液体输注是一线治疗方法。虽然可以通过预测前负荷依赖性来滴定液体冲击量，但评估其他形式的液体量可能更为复杂。我们在一家三级医院进行了一项回顾性分析，以评估在ICU住院早期给予的冲击量液体与总液体摄入量之间的比例，并评估液体策略对ICU死亡率的影响。从电子健康记录系统（ICCA®，飞利浦医疗）导出与ICU住院前四天液体输注相关的数据。人口统计学数据、严重程度评分、ICU入院时去甲肾上腺素剂量、总体液体平衡以及所输注总体积中不同液体成分的百分比被纳入多变量逻辑回归模型，以评估与ICU生存的相关性。

结果

我们分析了2021年7月1日至2023年12月31日期间因脓毒性休克和脓毒症诱导的低血压入院的220例患者。液体冲击量和维持量占总液体摄入量的49.3%±22.8%，其中平衡液占比最高（40.4%±22.0%）。药物输注的液体量占总液体摄入量的34.0%±2.9%，而口服或经鼻胃管摄入的液体量占总液体摄入量的18.0%±15.7%。在四天内，冲击量给予的液体量占总液体摄入量的8.6%，从第1天的25.1%±24.0%降至第4天的4.8%±8.7%。正液体平衡[比值比1.167（范围1.029 - 1.341）；p = 0.021]是与ICU死亡率相关的最重要因素。非幸存者（n = 66；30%）仅在第1天接受的总输入量高于幸存者[2493毫升对1855毫升；p = 0.022]。