Zhou Dawei, Lv Yi, Wang Chao, Li Dan
Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
BMC Anesthesiol. 2025 Feb 20;25(1):91. doi: 10.1186/s12871-025-02954-x.
Fluid supplement may be affected by ventilatory management due to physiological interaction between heart and lung. The aim of the present study was to explore the effects of ventilator strategies on the relationship of fluid balance and hospital mortality for sepsis patients.
This was a retrospective cohort study included sepsis patients with invasive mechanical ventilation (MV) over 24 h from Medical Information Mart for Intensive Care (MIMIC) IV database. The accumulative fluid balance increased by 6 h intervals were calculated as fluid intake minus fluid output. The modes (assisted or controlled) and levels (high or low) of positive end-expiratory pressure (PEEP) of MV every 6 h were recorded. The modification effect for modes and levels of PEEP on the relationship of fluid balance and hospital mortality were tested by multivariable regression models, respectively.
A total of 4466 sepsis patients with invasive MV were included, of which hospital mortality was 26.5%. Fluid balance seemed to have U-shape relationship with hospital mortality. The majority of patients used controlled ventilation at the beginning, and switched to assisted ventilation gradually; however, the PEEP level did not change a lot during the first 24 h. The relationship between fluid balance and hospital mortality was not modified by the ventilator mode; while the PEEP level may modify the relationship.
For sepsis patients admitted to ICU with invasive MV, the PEEP level, but not the mode of MV, appeared to modify the relationship of fluid balance and hospital mortality. The setting of mechanical ventilation may be an important consideration for fluid therapy.
由于心肺之间的生理相互作用，液体补充可能会受到通气管理的影响。本研究的目的是探讨通气策略对脓毒症患者液体平衡与医院死亡率关系的影响。
这是一项回顾性队列研究，纳入了医学重症监护信息数据库（MIMIC）IV中接受有创机械通气（MV）超过24小时的脓毒症患者。以每6小时计算的累计液体平衡增加量为液体摄入量减去液体输出量。记录每6小时MV的呼气末正压（PEEP）模式（辅助或控制）和水平（高或低）。分别通过多变量回归模型检验PEEP模式和水平对液体平衡与医院死亡率关系的修正作用。
共纳入4466例接受有创MV的脓毒症患者，其中医院死亡率为26.5%。液体平衡与医院死亡率似乎呈U形关系。大多数患者开始时采用控制通气，随后逐渐转为辅助通气；然而，在最初24小时内PEEP水平变化不大。通气模式未改变液体平衡与医院死亡率之间的关系；而PEEP水平可能会改变这种关系。
对于入住ICU并接受有创MV的脓毒症患者，似乎是PEEP水平而非MV模式改变了液体平衡与医院死亡率之间的关系。机械通气的设置可能是液体治疗的一个重要考虑因素。
