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

IF 1.4 4区 医学 Q3 CRITICAL CARE MEDICINE Critical Care and Resuscitation Pub Date : 2024-03-01 DOI:10.1016/j.ccrj.2023.11.005
Martin Faltys MD , Ary Serpa Neto MD , Luca Cioccari MD
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引用次数: 0

摘要

目的流体栓塞疗法(FBT)在心脏手术后的重症监护病房(ICU)中无处不在。然而,其生理效应仍不明确:我们进行了一项基于电子健康记录的心脏手术后 ICU 准实验研究。我们采用倾向得分匹配法,将 FBT 后的生理变化与匹配的对照组进行了比较,对照组在生理状况相同的情况下未给予液体栓剂。主要结果测量FBT后60分钟内心输出量(CO)和平均动脉压(MAP)的变化。结果我们分析了3572次匹配的栓注液体(FB)。FBT 后,CO 在 10 分钟内增加,但对照组没有增加,在 40 分钟时最大增加 0.2 升/分钟(95%CI 0.1 至 0.2)或比基线高出 4%(与对照组相比,P < 0.0001)。在 60.6% 的 FBT 患者和 49.1% 的对照组患者中,CO 比基线增加了 >10%(p <0.0001)。与 53.4% 的对照组相比,51.7% 的 FBT 患者的 MAP 增加了 > 10%。结论在这项针对心脏手术患者的 ICU 准实验性对比研究中,FBT 与 CO 的增加有显著的统计学意义,但数值较小。近一半的 FBT 未能引起 CO 或 MAP 的积极反应。
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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.

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来源期刊
Critical Care and Resuscitation
Critical Care and Resuscitation CRITICAL CARE MEDICINE-
CiteScore
7.70
自引率
3.40%
发文量
44
审稿时长
>12 weeks
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.
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