{"title":"心脏手术患者接受液体栓塞治疗后的生理变化:倾向得分匹配病例对照研究","authors":"Martin Faltys MD , Ary Serpa Neto MD , Luca Cioccari MD","doi":"10.1016/j.ccrj.2023.11.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>Fluid bolus therapy (FBT) is ubiquitous in intensive care units (ICUs) after cardiac surgery. However, its physiological effects remain unclear.</p></div><div><h3>Design</h3><p><strong>:</strong> 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.</p></div><div><h3>Setting</h3><p>The study was conducted in a multidisciplinary ICU of a tertiary-level academic hospital.</p></div><div><h3>Participants</h3><p>The study included 2,736 patients who underwent Coronary Artery Bypass Grafting and/or heart valve surgery.</p></div><div><h3>Main Outcome Measures</h3><p>Changes in cardiac output (CO) and mean arterial pressure (MAP) during the 60 minutes following FBT.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022287/pdfft?md5=c05f831073f20bf5fd98bb007a054e85&pid=1-s2.0-S1441277223022287-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Physiological changes after fluid bolus therapy in cardiac surgery patients: A propensity score matched case–control study\",\"authors\":\"Martin Faltys MD , Ary Serpa Neto MD , Luca Cioccari MD\",\"doi\":\"10.1016/j.ccrj.2023.11.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>Fluid bolus therapy (FBT) is ubiquitous in intensive care units (ICUs) after cardiac surgery. However, its physiological effects remain unclear.</p></div><div><h3>Design</h3><p><strong>:</strong> 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.</p></div><div><h3>Setting</h3><p>The study was conducted in a multidisciplinary ICU of a tertiary-level academic hospital.</p></div><div><h3>Participants</h3><p>The study included 2,736 patients who underwent Coronary Artery Bypass Grafting and/or heart valve surgery.</p></div><div><h3>Main Outcome Measures</h3><p>Changes in cardiac output (CO) and mean arterial pressure (MAP) during the 60 minutes following FBT.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>\",\"PeriodicalId\":49215,\"journal\":{\"name\":\"Critical Care and Resuscitation\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2024-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S1441277223022287/pdfft?md5=c05f831073f20bf5fd98bb007a054e85&pid=1-s2.0-S1441277223022287-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care and Resuscitation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1441277223022287\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care and Resuscitation","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1441277223022287","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Physiological changes after fluid bolus therapy in cardiac surgery patients: A propensity score matched case–control study
Objective
Fluid bolus therapy (FBT) is ubiquitous in intensive care units (ICUs) after cardiac surgery. However, its physiological effects remain unclear.
Design
: 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.
Setting
The study was conducted in a multidisciplinary ICU of a tertiary-level academic hospital.
Participants
The study included 2,736 patients who underwent Coronary Artery Bypass Grafting and/or heart valve surgery.
Main Outcome Measures
Changes in cardiac output (CO) and mean arterial pressure (MAP) during the 60 minutes following FBT.
Results
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.
Conclusion
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.
期刊介绍:
ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines.
The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world.
The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.