scholarly journals Examination of the association of steroids with fluid accumulation in critically ill patients, considering the possibility of biases

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Amit Frenkel ◽  
Ran Abuhasira ◽  
Yoav Bichovsky ◽  
Anton Bukhin ◽  
Victor Novack ◽  
...  
Keyword(s):  
Fluid Balance ◽  
Regression Models ◽  
Positive Fluid Balance ◽  
Fluid Accumulation ◽  
Glucocorticoid Treatment ◽  
The Third ◽  
Icu Stay ◽  
Selection Of Variables ◽  
Mineralocorticoid Activity ◽  
Selection Of

AbstractGlucocorticoids might have significant influence on positive fluid balance, mostly due to their mineralocorticoid effect. We assessed the association between glucocorticoid therapy and fluid balance in septic patients, in the intensive care unit (ICU). We considered two definitions of exposure: daily exposure to glucocorticoids and glucocorticoid treatment at any time. Of 945 patients, 375 were treated with glucocorticoids in the ICU. We applied four regression models. In the first, fluid balance did not differ during days with and without glucocorticoid treatment, among patients treated and not treated with glucocorticoids in the ICU. In our second model, daily fluid balance was increased in patients who were ever treated with glucocorticoids during their ICU stay compared to untreated patients. In the third model, which included only patients treated with glucocorticoids during their ICU stay, glucocorticoid treatment days were not associated with daily fluid balance. In the last model, on "steroid-free days", patients who received glucocorticoid treatment during their ICU stay had a positive fluid balance compared to those who were never treated with steroids. Despite their known mineralocorticoid activity, glucocorticoids themselves appear not to contribute substantially to fluid retention. This work highlights the importance of precise selection of variables to mitigate biases.

scholarly journals The possible association of steroids with fluid accumulation in critically ill patients – a case of a potential bias

2020 ◽  
Author(s):  
Amit Frenkel ◽  
Ran Abuhasira ◽  
Yoav Bichovsky ◽  
Anton Bukhin ◽  
Victor Novack ◽  
...  
Keyword(s):  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
P Value ◽  
Positive Fluid Balance ◽  
Coefficient Estimate ◽  
Icu Stay ◽  
Model Fluid ◽  
Definition Of ◽  
Mineralocorticoid Activity

Abstract Background: Glucocorticoids (GCS) are commonly administered to critically ill patients. Due to their mineralocorticoid effect, GCS might have a substantial influence on a positive fluid balance. We assessed the association between glucocorticoids (GCS) therapy and fluid balance in critically ill patients with sepsis.Methods: This is a retrospective study of patients with sepsis hospitalized during 2006-2018 in a general intensive care unit (ICU) at a 1100-bed tertiary medical center.Results – We considered two definitions of exposure: daily exposure to GCS and GCS treatment at any time in the ICU. Of 945 patients with a diagnosis of sepsis, 375 were treated with GCS at any time and 570 were not. We applied four regression models to assess the association between GCS treatment and fluid balance; in our first model, fluid balance did not differ during days with GCS treatment, between patients who were and were not treated with GCS in the ICU (coefficient estimate 79.5 (-55.4 to 214.4), p=0.25). In our second model, daily fluid balance was increased by 139.8 ml (10.8 to 268.9; p=0.03) in patients who were ever treated with GCS during their ICU stay compared to untreated patients. In the third model, which included only patients treated with GCS during their ICU stay, GCS treatment days were not associated with daily fluid balance (coefficient estimate -190.6 (-485.1 to 103.9), p-value=0.21). In the last model, on "steroid free days", patients who received GCS treatment during their ICU stay had a positive fluid balance compared to those who were never treated with steroids (coefficient estimate 157.7 (-24.6 to 340.1), p-value=0.09).Conclusions – Despite their known mineralocorticoid activity, GCS themselves appear not to contribute substantially to fluid retention. The findings highlight the importance of a clear definition of exposure.

Pathophysiology of Volume Administration in Septic Shock and the Role of the Clinical Pharmacist

2019 ◽  
Vol 54 (4) ◽  
pp. 388-396
Author(s):  
Brittany D. Bissell ◽  
Breanne Mefford
Keyword(s):  
Septic Shock ◽  
Critical Care ◽  
Patient Care ◽  
Fluid Balance ◽  
Clinical Pharmacist ◽  
Improve Patient Care ◽  
Positive Fluid Balance ◽  
Medline Search ◽  
Icu Stay ◽  
Organ Systems

Objective: To review physiological rationale and evidence base surrounding fluid harm to prepare the clinical pharmacist for accountability regarding volume-related outcomes. Data Sources: A PubMed/MEDLINE search was conducted using the following terms: (fluid therapy) AND [(critical care) OR (sepsis)] from 1966 to August 2019 published in English. Study Selection and Data Extraction: A total of 3364 citations were reviewed with only relevant clinical data extracted. Data Synthesis: Although early fluid resuscitation may be a necessary component to decrease mortality in the majority of patients with septic shock admitted to the intensive care unit (ICU), the benefit of continued administration after the first 24 hours is uncertain. Paradoxically, a positive fluid balance secondary to intravenous fluid receipt has been associated with diverse and perpetuating detriment on a multitude of organ systems after the first 24 hours of ICU stay. Continued clinical harm has been demonstrated on patient outcomes such as rates of mortality and length of stay. Despite the growing body of evidence supporting the potential adverse aspects of positive fluid balance, fluid overload remains common during critical care admission. Conclusion: Physiological concerns to overly zealous fluid administration and subsequent volume overload are vast. Relevance to Patient Care and Clinical Practice: Optimization of fluid balance in critically ill patients with sepsis is primed for clinical pharmacy intervention. Critical care pharmacists have the potential to improve patient care by optimizing fluid pharmacotherapy while potentially reducing adverse events, days on mechanical ventilation, and length of ICU stay.

Displace of Documentary Heritage from the Soviet Union to Poland during the Third Decade of the XXth Century

2014 ◽  
Vol 3 ◽  
pp. 127-137
Author(s):  
Tatsiana Hiarnovich
Keyword(s):  
Soviet Union ◽  
International Agreements ◽  
Peace Treaty ◽  
Actual Process ◽  
Xxth Century ◽  
The Third ◽  
The Soviet Union ◽  
History Of ◽  
Selection Of

The paper explores the displace of Polish archives from the Soviet Union that was performed in 1920s according to the Riga Peace Treaty of 1921 and other international agreements. The aim of the research is to reconstruct the process of displace, based on the archival sources and literature. The object of the research is those documents that were preserved in the archives of Belarus and together with archives from other republics were displaced to Poland. The exploration leads to clarification of the selection of document fonds to be displaced, the actual process of movement and the explanation of the role that the archivists of Belarus performed in the history of cultural relationships between Poland and the Soviet Union. The articles of the Treaty of Riga had been formulated without taking into account the indivisibility of archive fonds that is one of the most important principles of restitution, which caused the failure of the treaty by the Soviet part.

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