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Crit Care Med. 2018 Oct;46(10):1600-1607. doi: 10.1097/CCM.0000000000003276.

Deresuscitation of Patients With Iatrogenic Fluid Overload Is Associated With Reduced Mortality in Critical Illness.

Author information

1
Centre for Experimental Medicine, Queen's University of Belfast, Belfast, United Kingdom.
2
Department of Critical Care, Belfast Health and Social Care Trust, Belfast, United Kingdom.
3
Academic Department of Critical Care, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.
4
Department of Critical Care, Saint Michael's Hospital, Toronto, ON, Canada.
5
Intensive Care Unit, Mount Sinai Hospital, Toronto, ON, Canada.
6
Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
7
Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto, ON, Canada.
8
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
9
Intensive Care Unit, Altnagelvin Area Hospital, Western Health and Social Care Trust, Londonderry, United Kingdom.
10
Intensive Care Unit, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, United Kingdom.
11
Intensive Care Unit, Ulster Hospital, South-Eastern Health and Social Care Trust, Dundonald, United Kingdom.
12
Intensive Care Unit, Craigavon Hospital, Southern Health and Social Care Trust, Portadown, United Kingdom.

Abstract

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.

PMID:
29985214
DOI:
10.1097/CCM.0000000000003276
[Indexed for MEDLINE]

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