| Abstract [eng] |
Intravenous fluid therapy is the most frequent intervention for acutely ill critical patients. Excessive fluid administration combined with critical illness-induced vascular permeability in critically ill patients often leads to fluid overload, which is held for one of the factors contributing to adverse outcomes and increased mortality in critical patients. There is no universally agreed precise definition of fluid overload and no consistent method for its diagnosis in the scientific community. As direct or accurate measures of patients' body fluid status are also not currently available, indirect data are commonly used in practice. To date, research has mainly investigated resuscitation fluid administration, but it is believed that daily fluid intake throughout the entire duration of intensive care unit (ICU) treatment may also be a clinically relevant source of fluid overload and may be related to patient outcomes in ICU treatment. The aim of this study: to evaluate the methods of fluid therapy administration in three ICU’s departments of Vilnius University Hospital Santaros Clinics, their association with clinical outcomes and to provide recommendations for therapy optimization. Objectives: 1) To determine the prevalence of fluid overload in the patient population and to assess its association with fluid volume administered over 24 hours and throughout the ICU treatment period; 2) to assess the association of fluid overload and cumulative fluid balance with treatment outcomes. 3) To provide recommendations for optimizing fluid therapy in above mentioned ICU units. Methodology. A prospective observational study was conducted including 65 patients acutely hospitalized in ICU. Data on fluid intake, fluid balance and clinical outcomes were collected. Statistical analyses were performed using Mann Whitney-U and Spearman correlation tests, Fisher's exact criteria, relative risk and odds ratio analysis and logistic regression. Results: 64.6% of patients were found to have fluid overload on the third ICU day and 60% on the day of discharge. A positive association was found in these patients to the administration of higher levels of fluid creep, average daily and total fluid intake during the stay on the ICU. Fluid overload on the last day of treatment was associated with higher 28-days mortality (OR = 26.0; p = 0.001), as well as higher 90-days mortality (OR = 7.50; p = 0.008) Cumulative fluid balance was an independent predictor of 28-days mortality (p = 0.008) but was not significant in the prediction of the 90-days outcome. Conclusions: fluid overload was common in the study population and was associated with higher fluid intake. Fluid overload, especially on discharge date, is associated with higher 28- and 90-days mortality. It is recommended that more attention be paid to monitoring fluid creep, assessing cumulative balance and reducing infusion fluid therapy once the patient's condition has stabilised. |
