by Silversides, Jonathan
A.; Fitzgerald, Emma; Manickavasagam, Uma S.; Lapinsky, Stephen E.; Nisenbaum,
Rosane; Hemmings, Noel; Nutt, Christopher; Trinder, T. John; Pogson, David G.;
Fan, Eddy; Ferguson, Andrew J.; McAuley, Daniel F.; Marshall, John C.; for the
Role of Active Deresuscitation After Resuscitation (RADAR) Investigators
Objectives: To
characterize current practice in fluid administration and deresuscitation
(removal of fluid using diuretics or renal replacement therapy), the
relationship between fluid balance, deresuscitative measures, and outcomes and
to identify risk factors for positive fluid balance in critical illness.
Design:
Retrospective cohort study. Setting: Ten ICUs in the United Kingdom and Canada.
Patients: Adults receiving invasive mechanical ventilation for a minimum of 24
hours. Interventions: None. Measurements and Main Results: Four-hundred
patients were included. Positive cumulative fluid balance (fluid input greater
than output) occurred in 87.3%: the largest contributions to fluid input were
from medications and maintenance fluids rather than resuscitative IV fluids. In
a multivariate logistic regression model, fluid balance on day 3 was an
independent risk factor for 30-day mortality (odds ratio 1.26/L [95% CI,
1.07–1.46]), whereas negative fluid balance achieved in the context of
deresuscitative measures was associated with lower mortality. Independent
predictors of greater fluid balance included treatment in a Canadian site.
Conclusions: Fluid
balance is a practice-dependent and potentially modifiable risk factor for
adverse outcomes in critical illness. Negative fluid balance achieved with
deresuscitation on day 3 of ICU stay is associated with improved patient
outcomes. Minimization of day 3 fluid balance by limiting maintenance fluid
intake and drug diluents, and using deresuscitative measures, represents a
potentially beneficial therapeutic strategy which merits investigation in
randomized trials.
No comments:
Post a Comment