The Impact of Fluid Balances in the First 48 Hours on Mortality in the Critically Ill Patients

IF 0.3 Q3 MEDICINE, GENERAL & INTERNAL International Medical Journal Malaysia Pub Date : 2020-11-09 DOI:10.31436/IMJM.V15I1.401
A. Ralib, N. Hamzah, Majdiah Syahirah Nasir, M. Nor
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引用次数: 4

Abstract

Introduction: There has been increasing evidence of detrimental effects of cumulative positive fluid balance in critically ill patients. The postulated mechanism of harm is the development of interstitial oedema, with resultant increase morbidity and mortality. We aim to assess the impact of positive fluid balance within the first 48 hours on mortality in our local ICU population. Methods: This was a secondary analysis of a single centre, prospective observational study. All ICU patients more than 18 years were screened for inclusion in the study. Admission of less than 48 hours, post-elective surgery and ICU readmission were excluded. Cumulative fluid balance either as volume or percentage of body weight from admission was calculated over 6, 24 and 48 hour period from ICU admission. Results: A total of 143 patients were recruited, of these 33 died. There were higher cumulative fluid balances at 6, 24 and 48 hours in non-survivors compared to survivors. However, after adjusted for severity of illness, APACHE II Score, they were not predictive of mortality. Sensitivity analysis on sub-cohort of patients with acute kidney injury (AKI) showed only an actual 48-hour cumulative fluid balance was independently predictive of mortality (1.21 (1.03 to 1.42)). Conclusions: Cumulative fluid balance was not independently predictive of mortality in a heterogenous group of critically ill patients. However, in subcohort of patients with AKI, a 48-hour cumulative fluid balance was independently predictive of mortality. An additional tile is thus added to the mosaic of findings on the impact of fluid balance in a hetergenous group of critically ill patients, and in sub-cohort of AKI patients.
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危重病人前48小时体液平衡对死亡率的影响
越来越多的证据表明,在危重患者中,积累性体液阳性平衡有不利影响。假定的危害机制是间质性水肿的发展,从而增加发病率和死亡率。我们的目的是评估48小时内体液平衡阳性对当地ICU患者死亡率的影响。方法:这是一项单中心前瞻性观察性研究的二次分析。所有18岁以上的ICU患者均被筛选纳入研究。入院时间小于48小时、择期手术后和再入ICU除外。计算ICU入院后6、24和48小时内的累积体液平衡(体积或体重百分比)。结果:共纳入143例患者,其中33例死亡。与幸存者相比,非幸存者在6、24和48小时的累积体液平衡更高。然而,在调整了疾病的严重程度,APACHE II评分后,它们不能预测死亡率。急性肾损伤(AKI)患者亚队列的敏感性分析显示,只有实际的48小时累积体液平衡能够独立预测死亡率(1.21(1.03 ~ 1.42))。结论:累积体液平衡不能独立预测异质危重患者组的死亡率。然而,在AKI患者亚队列中,48小时累积体液平衡可独立预测死亡率。因此,在一组不同类型的危重患者和AKI患者亚队列中,体液平衡的影响的研究结果中又增加了一项。
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来源期刊
International Medical Journal Malaysia
International Medical Journal Malaysia Medicine-Medicine (all)
CiteScore
0.40
自引率
0.00%
发文量
73
期刊介绍: International Medical Journal Malaysia (IMJM) is the official journal of the Kulliyyah (Faculty) of Medicine, International Islamic University Malaysia. It serves primarily as a forum for education and intellectual discourse for health professionals namely in clinical medicine but covers diverse issues relating to medical ethics, professionalism as well as medical developments and research in basic medical sciences. It also serves the unique purpose of highlighting issues and research pertaining to the Muslim world. Contributions to the IMJM reflect its international and multidisciplinary readership and include current thinking across a range of specialties, ethnicities and societies.
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