Exploration of Body Habitus and Fluid Overload in Critically Ill Patients

Abstract Background Fluid management is important for ensuring hemodynamic stability in critically ill patients but easily leads to fluid overload. However, the optimal fluid balance plot or range for critically ill patients is unknown. This study aimed to explore the dose-response relationship between fluid overload (FO) and hospital mortality in critically ill patients.Methods Data were derived from the China Critical Care Sepsis Trial (CCCST). Patients with sequential fluid data for the first 3 days of admission to the ICU were included. FO was expressed as the ratio of the cumulative fluid balance (L) and initial body weight (kg) at ICU admission as a percentage. Maximum fluid overload (MFO) was defined as the peak FO value during the first 3 days of ICU admission. We used logistic regression models with restricted cubic splines to assess the relationship between MFO and the risk of hospital mortality.ResultsIn total, 3850 patients were included, 929 (24.1%) of whom died in hospital. For each 1% L/kg increase in the FO, the risk of hospital mortality increased by 4% (HR 1.04, 95% CI 1.03 - 1.05, P < 0.001). FO greater than 10% was associated with a 44% increased HR of hospital mortality compared with FO less than 5% (HR 1.44, 95% CI 1.27 - 1.67). Notably, we also found a non-linear dose-response association between MFO and hospital mortality.Conclusions Both higher and lower fluid balance were associated with an increased risk of hospital mortality. Further studies should explore this relationship and seek for the optimal fluid management strategies for critically ill patients.

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Fluid overload and survival in critically ill patients with acute kidney injury receiving continuous renal replacement therapy

PLoS ONE ◽

10.1371/journal.pone.0172137 ◽

2017 ◽

Vol 12 (2) ◽

pp. e0172137 ◽

Cited By ~ 17

Author(s):

Il Young Kim ◽

Joo Hui Kim ◽

Dong Won Lee ◽

Soo Bong Lee ◽

Harin Rhee ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Fluid Overload ◽

Kidney Injury

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Dose–response association between fluid overload and in-hospital mortality in critically ill patients: a multicentre, prospective, observational cohort study

BMJ Open ◽

10.1136/bmjopen-2020-039875 ◽

2020 ◽

Vol 10 (12) ◽

pp. e039875

Author(s):

Meiping Wang ◽

Bo Zhu ◽

Li Jiang ◽

Ying Wen ◽

Bin Du ◽

...

Keyword(s):

Hospital Mortality ◽

Critically Ill ◽

Dose Response ◽

Fluid Balance ◽

Critically Ill Patients ◽

Fluid Overload ◽

Multivariable Analysis ◽

Main Diagnosis ◽

Icu Admission ◽

Increased Risk

ObjectivesFluid management is important in ensuring haemodynamic stability in critically ill patients, but can easily lead to fluid overload (FO). However, the optimal fluid balance plot or range for critically ill patients is unknown. This study aimed to explore the dose–response relationship between FO and in-hospital mortality in critically ill patients.DesignMulticentre, prospective, observational study.SettingEighteen intensive care units (ICUs) of 16 tertiary hospitals in China.ParticipantsCritically ill patients in the ICU for more than 3 days.Primary outcome measures and analysesFO was defined as the ratio of the cumulative fluid balance (L) and initial body weight (kg) on ICU admission, expressed as a percentage. Maximum FO was defined as the peak value of FO during the first 3 days of ICU admission. Logistic regression models with restricted cubic splines were used to explore the pattern and magnitude of the association between maximum FO and risk of in-hospital mortality. Age, sex, Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score on admission, main diagnosis on admission to ICU, comorbidities, time of maximum FO, mechanical ventilation, renal replacement therapy, use of vasopressors and centres were adjusted in multivariable analysis.ResultsA total of 3850 patients were included in the study, 929 (24.1%) of whom died in the hospital. For each 1% L/kg increase in maximum FO, the risk of in-hospital mortality increased by 4% (adjusted HR (aHR) 1.04, 95% CI 1.03 to 1.05, p<0.001). A maximum FO greater than 10% was associated with a 44% increased HR of in-hospital mortality compared with an FO less than 5% (aHR 1.44, 95% CI 1.27 to 1.67). Notably, we found a non-linear dose–response association between maximum FO and in-hospital mortality.ConclusionsBoth higher and negative fluid balance levels were associated with an increased risk of in-hospital mortality in critically ill patients.Trial registration numberChiCTR-ECH-13003934.

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Passive leg raising: Simple and reliable technique to prevent fluid overload in critically ill patients

International Journal of Preventive Medicine ◽

10.4103/ijpvm.ijpvm_11_17 ◽

2017 ◽

Vol 8 (1) ◽

pp. 48

Author(s):

Farahnak Assadi

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Fluid Overload ◽

Passive Leg Raising ◽

Reliable Technique

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Fluid overload is associated with an increased risk for 90-day mortality in critically ill patients with renal replacement therapy: data from the prospective FINNAKI study

Critical Care ◽

10.1186/cc11682 ◽

2012 ◽

Vol 16 (5) ◽

pp. R197 ◽

Cited By ~ 182

Author(s):

Suvi T Vaara ◽

Anna-Maija Korhonen ◽

Kirsi-Maija Kaukonen ◽

Sara Nisula ◽

Outi Inkinen ◽

...

Keyword(s):

Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Fluid Overload ◽

Increased Risk

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Fluid Overload in Critically Ill Patients with Acute Kidney Injury

Blood Purification ◽

10.1159/000287776 ◽

2010 ◽

Vol 29 (4) ◽

pp. 331-338 ◽

Cited By ~ 40

Author(s):

Jorge Cerda ◽

Geoffrey Sheinfeld ◽

Claudio Ronco

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Fluid Overload ◽

Kidney Injury

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Medication Regimen Complexity Score as an Indicator of Fluid Balance in Critically Ill Patients

Journal of Pharmacy Practice ◽

10.1177/0897190021999792 ◽

2021 ◽

pp. 089719002199979

Author(s):

William J. Olney ◽

Aaron M. Chase ◽

Sarah A. Hannah ◽

Susan E. Smith ◽

Andrea Sikora Newsome

Keyword(s):

Critically Ill ◽

Fluid Balance ◽

Critically Ill Patients ◽

Fluid Overload ◽

Medication Regimen ◽

Icu Admission ◽

Medication Regimen Complexity ◽

Increased Risk ◽

Regimen Complexity ◽

The Relationship

Background: Critically ill patients are at increased risk for fluid overload, but objective prediction tools to guide clinical decision-making are lacking. The MRC-ICU scoring tool is an objective tool for measuring medication regimen complexity. Objective: To evaluate the relationship between MRC-ICU score and fluid overload in critically ill patients. Methods: In this multi-center, retrospective, observational study, the relationship between MRC-ICU and the risk of fluid overload was examined. Patient demographics, fluid balance at day 3 of ICU admission, MRC-ICU score at 24 hours, and clinical outcomes were collected from the medical record. The primary outcome was relationship between MRC-ICU and fluid overload. To analyze this, MRC-ICU scores were divided into tertiles (low, moderate, high), and binary logistic regression was performed. Linear regression was performed to determine variables associated with positive fluid balance. Results: A total of 125 patients were included. The median MRC-ICU score at 24 hours of ICU admission for low, moderate, and high tertiles were 9, 15, and 21, respectively. For each point increase in MRC-ICU, a 13% increase in the likelihood of fluid overload was observed (OR 1.128, 95% CI 1.028-1.238, p = 0.011). The MRC-ICU score was positively associated with fluid balance at day 3 (β-coefficient 218.455, 95% CI 94.693-342.217, p = 0.001) when controlling for age, gender, and SOFA score. Conclusions: Medication regimen complexity demonstrated a weakly positive correlation with fluid overload in critically ill patients. Future studies are necessary to establish the MRC-ICU as a predictor to identify patients at risk of fluid overload.

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