Acute and Critical Care

Original Articles

CPR/Resuscitation
Percent fluid overload for prediction of fluid de-escalation in critically ill patients in Saudi Arabia: a prospective observational study: Reham A. Alharbi, Namareq F. Aldardeer, Emily L. G. Heaphy, Ahmad H. Alabbasi, Amjad M. Albuqami, Hassan Hawa; Acute Crit Care. 2023;38(2):209-216. Published online May 16, 2023; DOI: https://doi.org/10.4266/acc.2022.01550

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Abstract PDF Supplementary Material: Background
Percent fluid overload greater than 5% is associated with increased mortality. The appropriate time for fluid deresuscitation depends on the patient's radiological and clinical findings. This study aimed to assess the applicability of percent fluid overload calculations for evaluating the need for fluid deresuscitation in critically ill patients.
Methods
This was a single-center, prospective, observational study of critically ill adult patients requiring intravenous fluid administration. The study's primary outcome was median percent fluid accumulation on the day of fluid deresuscitation or intensive care unit (ICU) discharge, whichever came first.
Results
A total of 388 patients was screened between August 1, 2021, and April 30, 2022. Of these, 100 with a mean age of 59.8±16.2 years were included for analysis. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 15.4±8.0. Sixty-one patients (61.0%) required fluid deresuscitation during their ICU stay, while 39 (39.0%) did not. Median percent fluid accumulation on the day of deresuscitation or ICU discharge was 4.5% (interquartile range [IQR], 1.7%–9.1%) and 5.2% (IQR, 2.9%–7.7%) in patients requiring deresuscitation and those who did not, respectively. Hospital mortality occurred in 25 (40.9%) of patients with deresuscitation and six (15.3%) patients who did not require it (P=0.007).
Conclusions
The percent fluid accumulation on the day of fluid deresuscitation or ICU discharge was not statistically different between patients who required fluid deresuscitation and those who did not. A larger sample size is needed to confirm these findings.

Surgery
Association between postoperative fluid balance and mortality and morbidity in critically ill patients with complicated intra-abdominal infections: a retrospective study: Joohyun Sim, Jae Young Kwak, Yun Tae Jung; Acute Crit Care. 2020;35(3):189-196. Published online August 19, 2020; DOI: https://doi.org/10.4266/acc.2020.00031

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7 Crossref

Background
Postoperative fluid overload may increase the risk of developing pulmonary complications and other adverse outcomes. We evaluated the impact of excessive fluid administration on postoperative outcomes in critically ill patients.
Methods
We reviewed the medical records of 320 patients admitted to intensive care unit (ICU) after emergency abdominal surgery for complicated intra-abdominal infection (cIAI) between January 2013 and December 2018. The fluid balance data of the patients were reviewed for a maximum of 7 days. The patients were grouped based on average daily fluid balance with a cutoff value of 20 ml/kg/day. Propensity score matching was performed to reduce the underlying differences between the groups.
Results
Patients with an average daily fluid balance of ≥20 ml/kg/day were associated with higher rates of 30-day mortality (11.8% vs. 2.4%; P=0.036) than those with lower fluid balance (<20 ml/kg/day). Kaplan-Meier survival curves for 30-day mortality in these groups also showed a better survival rate in the lower fluid balance group with a statistical significance (P=0.020). The percentage of patients who developed pulmonary consolidation during ICU stay (47.1% vs. 24.7%; P=0.004) was higher in the fluid-overloaded group. Percentages of newly developed pleural effusion (61.2% vs. 57.7%; P=0.755), reintubation (18.8% vs. 10.6%; P=0.194), and infectious complications (55.3% vs. 49.4%; P=0.539) showed no significant differences between the two groups.
Conclusions
Postoperative fluid overload in patients who underwent emergency surgery for cIAI was associated with higher 30-day mortality and more frequent occurrence of pulmonary consolidation. Postoperative fluid balance should be adjusted carefully to avoid adverse clinical outcomes.

Citations

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Complications during Veno-Venous Extracorporeal Membrane Oxygenation in COVID-19 and Non-COVID-19 Patients with Acute Respiratory Distress Syndrome
Andrea Bruni, Caterina Battaglia, Vincenzo Bosco, Corrado Pelaia, Giuseppe Neri, Eugenio Biamonte, Francesco Manti, Annachiara Mollace, Annalisa Boscolo, Michele Morelli, Paolo Navalesi, Domenico Laganà, Eugenio Garofalo, Federico Longhini
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The Association Between Fluid Management and Intraoperative Blood Pressure and Patients’ Outcome After Complex Spine Surgeries
Ye Rin Koh, Yufei Li, Joan Koh, Elyad Ekrami, Xiaodan Liu, Maged Y. Argalious, Mariel R. Manlapaz, Christopher A. Troianos, Michael P. Steinmetz, Ehab Farag
Anesthesia & Analgesia.2024;[Epub] CrossRef
Fluid balance following laparotomy for hollow viscus perforation: A study of morbidity and mortality
James Tankel, David Chayen, Sharon Einav
Surgery in Practice and Science.2023; 12: 100146. CrossRef
Risk of fluid accumulation after cardiac surgery
Atte Koskinen, Jenni Aittokallio, Jarmo Gunn, Joonas Lehto, Arto Relander, Emma Viikinkoski, Tuija Vasankari, Juho Jalkanen, Maija Hollmén, Tuomas O. Kiviniemi
JTCVS Open.2023; 16: 602. CrossRef
Loop diuretics in adult intensive care patients with fluid overload: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis
Sine Wichmann, Marija Barbateskovic, Ning Liang, Theis Skovsgaard Itenov, Rasmus Ehrenfried Berthelsen, Jane Lindschou, Anders Perner, Christian Gluud, Morten Heiberg Bestle
Annals of Intensive Care.2022;[Epub] CrossRef
Goal directed fluid removal with furosemide versus placebo in intensive care patients with fluid overload: A trial protocol for a randomised, blinded trial (GODIF trial)
Sine Wichmann, Theis S. Itenov, Rasmus E. Berthelsen, Theis Lange, Anders Perner, Christian Gluud, Pia Lawson‐Smith, Lars Nebrich, Jørgen Wiis, Anne C. Brøchner, Thomas Hildebrandt, Meike T. Behzadi, Kristian Strand, Finn H. Andersen, Thomas Strøm, Mikko
Acta Anaesthesiologica Scandinavica.2022; 66(9): 1138. CrossRef
Lung Ultrasound-Guided Fluid Management versus Standard Care in Surgical ICU Patients: A Randomised Controlled Trial
Daniel-Mihai Rusu, Ioana Grigoraș, Mihaela Blaj, Ianis Siriopol, Adi-Ionut Ciumanghel, Gigel Sandu, Mihai Onofriescu, Olguta Lungu, Adrian Constantin Covic
Diagnostics.2021; 11(8): 1444. CrossRef

Review Article

Cardiology/Surgery/Basic science and research
The Complexities of Intravenous Fluid Research: Questions of Scale, Volume, and Accumulation: Neil J Glassford, Rinaldo Bellomo; Korean J Crit Care Med. 2016;31(4):276-299. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00934

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602 Download
19 Crossref

Abstract PDF

Despite near ubiquity, information regarding fluids consumption at a health care systems level, and patient exposure at an individual level, is surprisingly limited in the medical literature. The epidemiology of the foundational medical intervention of intravenous fluid administration is incredibly complex, with millions of patients being exposed internationally every year. Fluid is being given for different reasons, to different targets, following different triggers, by different specialties in different countries, and any observations that can be made are thought to have limited external validity to other jurisdictions and patient groups. The independent effects of fluid administration and fluid accumulation are very hard to separate from other markers of illness severity and aspects of the process of care. Fluid accumulation can result in organ injury, even when the fluid is being given to purportedly ameliorate or prevent such injury, and if it were independently associated with mortality then would be an easily accessible and modifiable risk factor for subsequent morbidity or death. Despite their ubiquity, it is clear that we have limited understanding of the effects of the intravenous fluids we use daily in the most vulnerable of patient groups. The research agenda in this field is large and urgent.

Citations

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Appropriateness of intravenous fluid prescriptions in hospitalised patients: a point prevalence study
Barbara Sneyers, Caroline Nyssen, Pierre Bulpa, Isabelle Michaux, Dominique Lacrosse, Philippe E. Dubois, Thomas Rotens, Anne Spinewine
International Journal of Clinical Pharmacy.2025; 47(1): 136. CrossRef
Uso de fluidoterapia en el periodo perioperatorio en pacientes adultos: revisión narrativa
M.J. Colomina, P. Galán Menéndez, J. Ripollés-Melchor
Revista Española de Anestesiología y Reanimación.2024; 71(10): 748. CrossRef
Use of fluid therapy in perioperative adult patients: A narrative review
M.J. Colomina, P. Galán Menéndez, J. Ripollés-Melchor
Revista Española de Anestesiología y Reanimación (English Edition).2024; 71(10): 748. CrossRef
The Precision Resuscitation With Crystalloids in Sepsis (PRECISE) Trial
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JAMA Network Open.2024; 7(9): e2434197. CrossRef
A cost effectiveness analysis of a quality improvement intervention to increase preferential balanced fluid prescribing
Michelle C. Spiegel, Kit N. Simpson, Annie N. Simpson, Andrew J. Goodwin
BMC Health Services Research.2024;[Epub] CrossRef
Closed-Loop Control of Fluid Resuscitation Using Reinforcement Learning
Elham Estiri, Hossein Mirinejad
IEEE Access.2023; 11: 140569. CrossRef
Fluid Stewardship of Maintenance Intravenous Fluids
John R. Carr, W. Anthony Hawkins, Andrea Sikora Newsome, Susan E. Smith, Clemmons Amber B, Christopher M. Bland, Trisha N. Branan
Journal of Pharmacy Practice.2022; 35(5): 769. CrossRef
Clinician attitudes and concordance with self-assessed and actual intravenous fluid prescribing patterns: A single-institution evaluation of survey and electronic prescribing data
Michelle C. Spiegel, Annie N. Simpson, Nandita R. Nadig, Dee W. Ford, Andrew J. Goodwin
The American Journal of the Medical Sciences.2022; 364(1): 36. CrossRef
Acetate‐ versus lactate‐buffered crystalloid solutions: A systematic review with meta‐analysis and trial sequential analysis
Karen Louise Ellekjaer, Anders Perner, Praleene Sivapalan, Morten Hylander Møller
Acta Anaesthesiologica Scandinavica.2022; 66(7): 782. CrossRef
A fuzzy model for predicting burn patients’ intravenous fluid resuscitation rate
Sayma Alam Suha, M. Akhtaruzzaman, Tahsina Farah Sanam
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Development and implementation of a clinical decision support-based initiative to drive intravenous fluid prescribing
Michelle C. Spiegel, Annie N. Simpson, Achsah Philip, Carolyn M. Bell, Nandita R. Nadig, Dee W. Ford, Andrew J. Goodwin
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Brittany D. Bissell, Breanne Mefford
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American Journal of Respiratory and Critical Care Medicine.2019; 199(8): 952. CrossRef
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Neil J. Glassford, Rinaldo Bellomo
Critical Care Clinics.2018; 34(2): 279. CrossRef
Resuscitation fluids
Jonathan D. Casey, Ryan M. Brown, Matthew W. Semler
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Utility of Volume Assessment Using Bioelectrical Impedance Analysis in Critically Ill Patients Receiving Continuous Renal Replacement Therapy: A Prospective Observational Study
Ki Hyun Park, Jung-ho Shin, Jin Ho Hwang, Su Hyun Kim
The Korean Journal of Critical Care Medicine.2017; 32(3): 256. CrossRef

Original Article

Predictors of Mortality and Complication in Pediatric Patients Who Require Continuous Renal Replacement Therapy in Pediatric Intensive Care Unit: Jae Wook Choi, Woo Jin Chung, Young Joo Han, Ju Kyung Lee, Dong In Suh, June Dong Park, Young Yull Koh; Korean J Crit Care Med. 2011;26(3):171-176.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.171

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Abstract PDF

BACKGROUND
The objective of this study is to analyze the factors associated with mortality and complication in children requiring continuous renal replacement therapy (CRRT) in a pediatric intensive care unit.
METHODS
We retrospectively analyzed 96 patients who required CRRT at a pediatric intensive care unit in Seoul National University Hospital between April 2005 and April 2011. We evaluated the clinical features, diagnosis, mortality risk factors and complications related to CRRT.
RESULTS
Univariate and multivariate analyses were performed to analyze the mortality risk factors of patients requiring CRRT. The overall mortality was 56.3%, the median age was 8 years, and the ages ranged from 4 days to 22 years. The median weight of the patients was 7.9 kg, and the weights ranged from 3.6-72.9 kg. 16 patients were diagnosed with primary renal disease, and the remainder with other underlying diseases. Mortality was higher in children who received stem cell transplantation and in children with a diagnosis of imunologic disease and neurologic disease. The Pediatric Risk of Mortality (PRISM) III score at initiating CRRT was 17.8 +/- 8.9 and the degree of fluid overload at CRRT (FO%) was 12.9 +/- 16.0. The PRISM III score at the start of CRRT and low uric acid level were the factors associated with an increased risk of mortality. Of the 96 children, 13 (13.53%) presented problems of venous catheterization. Hypotension during connection to CRRT was detected in 28 patients (29.2%). Clinically significant hemorrhage occurred in 10 patients (10.4%).
CONCLUSIONS
Children who require CRRT have a high mortality rate. The higher score of PRISM III at the starting time of CRRT and the lower uric acid level are the factors associated with a higher mortality. The most frequent complication of CRRT was hypotension on connection to CRRT.

Citations

Citations to this article as recorded by

Continuous Renal Replacement Therapy in the Neonatal Intensive Care Unit: A Single-Center Study
Moon-yeon Oh, Byong Sop Lee, Seong-Hee Oh, Hee Jin Jang, Hyun-Jeong Do, Ellen Ai-Rhan Kim, Ki-Soo Kim, Joo Hoon Lee, Young Seo Park, Beom-Hee Lee, Han-Wook Yoo
Neonatal Medicine.2014; 21(4): 244. CrossRef

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