Cumulative fluid balance predicts mortality and increases time on mechanical ventilation in ARDS patients: An observational cohort study
Autoři:
Niels van Mourik aff001; Hennie A. Metske aff001; Jorrit J. Hofstra aff002; Jan M. Binnekade aff002; Bart F. Geerts aff001; Marcus J. Schultz aff002; Alexander P. J. Vlaar aff002
Působiště autorů:
Department of Anaesthesiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
aff001; Department of Intensive Care Medicine, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
aff002
Vyšlo v časopise:
PLoS ONE 14(10)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0224563
Souhrn
Introduction
Acute respiratory distress syndrome (ARDS) is characterized by acute, diffuse, inflammatory lung injury leading to increased pulmonary vascular permeability, pulmonary oedema and loss of aerated tissue. Previous literature showed that restrictive fluid therapy in ARDS shortens time on mechanical ventilation and length of ICU-stay. However, the effect of intravenous fluid use on mortality remains uncertain. We investigated the relationship between cumulative fluid balance (FB), time on mechanical ventilation and mortality in ARDS patients.
Materials and methods
Retrospective observational study. Patients were divided in four cohorts based on cumulative FB on day 7 of ICU-admission: ≤0 L (Group I); 0–3.5 L (Group II); 3.5–8 L (Group III) and ≥8 L (Group IV). In addition, we used cumulative FB on day 7 as continuum as a predictor of mortality. Primary outcomes were 28-day mortality and ventilator-free days. Secondary outcomes were 90-day mortality and ICU length of stay.
Results
Six hundred ARDS patients were included, of whom 156 (26%) died within 28 days. Patients with a higher cumulative FB on day 7 had a longer length of ICU-stay and fewer ventilator-free days on day 28. Furthermore, after adjusting for severity of illness, a higher cumulative FB was associated with 28-day mortality (Group II, adjusted OR (aOR) 2.1 [1.0–4.6], p = 0.045; Group III, aOR 3.3 [1.7–7.2], p = 0.001; Group IV, aOR 7.9 [4.0–16.8], p<0.001). Using restricted cubic splines, a non-linear dose-response relationship between cumulative FB and probability of death at day 28 was found; where a more positive FB predicted mortality and a negative FB showed a trend towards survival.
Conclusions
A higher cumulative fluid balance is independently associated with increased risk of death, longer time on mechanical ventilation and longer length of ICU-stay in patients with ARDS. This underlines the importance of implementing restrictive fluid therapy in ARDS patients.
Klíčová slova:
Death rates – Chronic obstructive pulmonary disease – Intensive care units – Sepsis – Dose prediction methods – Acute respiratory distress syndrome – Observational studies
Zdroje
1. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526–33. Epub 2012/07/17. doi: 10.1001/jama.2012.5669 22797452.
2. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315(8):788–800. doi: 10.1001/jama.2016.0291 26903337
3. Carrasco Loza R, Villamizar Rodriguez G, Medel Fernandez N. Ventilator-Induced Lung Injury (VILI) in Acute Respiratory Distress Syndrome (ARDS): Volutrauma and Molecular Effects. Open Respir Med J. 2015;9:112–9. Epub 2015/08/28. doi: 10.2174/1874306401509010112 26312103; PubMed Central PMCID: PMC4541417.
4. Shaver CM, Bastarache JA. Clinical and Biological Heterogeneity in ARDS: Direct versus Indirect Lung Injury. Clin Chest Med. 2014;35(4):639–53. doi: 10.1016/j.ccm.2014.08.004 PMC4254695. 25453415
5. Malbrain ML, Marik PE, Witters I, Cordemans C, Kirkpatrick AW, Roberts DJ, et al. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther. 2014;46(5):361–80. Epub 2014/11/30. doi: 10.5603/AIT.2014.0060 25432556.
6. Lee J, de Louw E, Niemi M, Nelson R, Mark RG, Celi LA, et al. Association between fluid balance and survival in critically ill patients. J Intern Med. 2015;277(4):468–77. Epub 2014/06/17. doi: 10.1111/joim.12274 24931482; PubMed Central PMCID: PMC4265574.
7. Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564–75. Epub 2006/05/23. doi: 10.1056/NEJMoa062200 16714767.
8. Murphy CV, Schramm GE, Doherty JA, Reichley RM, Gajic O, Afessa B, et al. The importance of fluid management in acute lung injury secondary to septic shock. Chest. 2009;136(1):102–9. Epub 2009/03/26. doi: 10.1378/chest.08-2706 19318675.
9. Grams ME, Estrella MM, Coresh J, Brower RG, Liu KD. Fluid balance, diuretic use, and mortality in acute kidney injury. Clin J Am Soc Nephrol: CJASN. 2011;6(5):966–73. Epub 2011/03/12. doi: 10.2215/CJN.08781010 21393482; PubMed Central PMCID: PMC3087792.
10. Zhang Z, Chen L. The association between fluid balance and mortality in patients with ARDS was modified by serum potassium levels: a retrospective study. PeerJ. 2015;3:e752. Epub 2015/02/24. doi: 10.7717/peerj.752 25699202; PubMed Central PMCID: PMC4327251.
11. Vlaar AP, Binnekade JM, Prins D, van Stein D, Hofstra JJ, Schultz MJ, et al. Risk factors and outcome of transfusion-related acute lung injury in the critically ill: a nested case-control study. Crit Care Med. 2010;38(3):771–8. Epub 2009/12/26. doi: 10.1097/CCM.0b013e3181cc4d4b 20035217.
12. Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301–8. Epub 2000/05/04. doi: 10.1056/NEJM200005043421801 10793162.
13. Godin M, Bouchard J, Mehta RL. Fluid Balance in Patients with Acute Kidney Injury: Emerging Concepts. Nephron Clin Pract. 2013;123(3–4):238–45. doi: 10.1159/000354713 24008395
14. Rosenberg AL, Dechert RE, Park PK, Bartlett RH. Review of a large clinical series: association of cumulative fluid balance on outcome in acute lung injury: a retrospective review of the ARDSnet tidal volume study cohort. J Intensive Care Med. 2009;24(1):35–46. Epub 2008/12/24. doi: 10.1177/0885066608329850 19103612.
15. Maca J, Jor O, Holub M, Sklienka P, Bursa F, Burda M, et al. Past and Present ARDS Mortality Rates: A Systematic Review. Respir Care. 2017;62(1):113–22. Epub 2016/11/03. doi: 10.4187/respcare.04716 27803355.
16. Micek ST, McEvoy C, McKenzie M, Hampton N, Doherty JA, Kollef MH. Fluid balance and cardiac function in septic shock as predictors of hospital mortality. Crit Care. 2013;17(5):R246–R. doi: 10.1186/cc13072 PMC4056694. 24138869
17. Koonrangsesomboon W, Khwannimit B. Impact of positive fluid balance on mortality and length of stay in septic shock patients. Indian J Crit Care Med. 2015;19(12):708–13. doi: 10.4103/0972-5229.171356 PMC4711202. 26813080
18. Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011;39(2):259–65. Epub 2010/10/27. doi: 10.1097/CCM.0b013e3181feeb15 20975548.
19. Roch A, Guervilly C, Papazian L. Fluid management in acute lung injury and ards. Ann Intensive Care. 2011;1:16–. doi: 10.1186/2110-5820-1-16 PMC3224488. 21906342
20. Sakr Y, Vincent JL, Reinhart K, Groeneveld J, Michalopoulos A, Sprung CL, et al. High tidal volume and positive fluid balance are associated with worse outcome in acute lung injury. Chest. 2005;128(5):3098–108. Epub 2005/11/24. doi: 10.1378/chest.128.5.3098 16304249.
21. Uhlig C, Silva PL, Deckert S, Schmitt J, de Abreu MG. Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care. 2014;18(1):R10. Epub 2014/01/11. doi: 10.1186/cc13187 24405693; PubMed Central PMCID: PMC4056106.
22. Mikkelsen ME, Christie JD, Lanken PN, Biester RC, Thompson BT, Bellamy SL, et al. The adult respiratory distress syndrome cognitive outcomes study: long-term neuropsychological function in survivors of acute lung injury. Am J Respir Crit Care Med. 2012;185(12):1307–15. Epub 2012/04/12. doi: 10.1164/rccm.201111-2025OC 22492988; PubMed Central PMCID: PMC3381234.
23. Silversides JA, Fitzgerald E, Manickavasagam US, Lapinsky SE, Nisenbaum R, Hemmings N, et al. Deresuscitation of Patients With Iatrogenic Fluid Overload Is Associated With Reduced Mortality in Critical Illness. Crit Care Med. 2018. Epub 2018/07/10. doi: 10.1097/ccm.0000000000003276 29985214.
Článok vyšiel v časopise
PLOS One
2019 Číslo 10
- Metamizol jako analgetikum první volby: kdy, pro koho, jak a proč?
- Nejasný stín na plicích – kazuistika
- Masturbační chování žen v ČR − dotazníková studie
- Úspěšná resuscitativní thorakotomie v přednemocniční neodkladné péči
- Fixní kombinace paracetamol/kodein nabízí synergické analgetické účinky
Najčítanejšie v tomto čísle
- Correction: Low dose naltrexone: Effects on medication in rheumatoid and seropositive arthritis. A nationwide register-based controlled quasi-experimental before-after study
- Combining CDK4/6 inhibitors ribociclib and palbociclib with cytotoxic agents does not enhance cytotoxicity
- Experimentally validated simulation of coronary stents considering different dogboning ratios and asymmetric stent positioning
- Prevalence of pectus excavatum (PE), pectus carinatum (PC), tracheal hypoplasia, thoracic spine deformities and lateral heart displacement in thoracic radiographs of screw-tailed brachycephalic dogs