scholarly journals Point-of-Care Ultrasound-Guided Conservative Fluid Therapy Improved the Outcome of Critically Ill Patients: A Before-and-After Study

2021 ◽  
Author(s):  
Hui He ◽  
Mingqiang Zeng ◽  
Jing Chen ◽  
Lei Deng ◽  
Youdai Chen
Keyword(s):  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Apache Ii Score ◽  
Point Of Care Ultrasound ◽  
Icu Mortality ◽  
Icu Stay ◽  
The Impact ◽  
Cumulative Fluid Balance

Abstract ObjectivesTo study the impact of fluid balance on the outcome of critically ill patients.MethodsCritically ill patients managed with point-of-care ultrasound were compared with those managed without. Distended internal jugular veins and inferior vena cava with reduced collapsibility were taken as signs of hypervolemia.ResultsCompared with critically ill patients admitted before application of point-of-care ultrasound assessment (from March, 2019 through October, 2019; 291 cases), cases admitted after (from November, 2019 through June, 2020; 285 cases) had significantly lower in-ICU mortality (34.7% vs 26.7%, p=0.038; Fisher’s exact test), together with a dramatic change from overall positive fluid balance to negative one (for cumulative fluid balance during ICU stay, 2820±1381ml vs -10±39ml; p=0.001). Multiple logistic regression showed that cumulative fluid balance during ICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score on admission were independent risk factors for in-ICU mortality (p<0.001, p<0.001 and p=0.043 respectively). After controlling for disease severity, Cox hazard ratio of cases with a negative cumulative fluid balance during ICU stay was 0.683 (95% confidence interval 0.475-0.981; p=0039).ConclusionsNegative cumulative fluid balance during ICU stay was associated with a reduced in-ICU mortality.

scholarly journals Point-of-care ultrasound-guided conservative fluid therapy improved the outcome of critically ill patients: a before-and-after study

2020 ◽  
Author(s):  
Hui He ◽  
Mingqiang Zeng ◽  
Jing Chen ◽  
Lei Deng ◽  
youdai chen
Keyword(s):  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Vena Cava ◽  
Point Of Care Ultrasound ◽  
Icu Mortality ◽  
Jugular Veins ◽  
Icu Stay ◽  
Cumulative Fluid Balance

Abstract BackgroundThe danger of volume overload was not yet well understood and appreciated. Point-of-care ultrasound assessment of blood volume was not widely practiced.MethodsCritically ill patients managed with point-of-care ultrasound were compared with those managed without, in an intensive care unit (ICU) for medical and surgical cases. Distended internal jugular veins and inferior vena cava with reduced collapsibility were taken as signs of hypervolemia and negative fluid balance became a goal.ResultsCompared with critically ill patients admitted before application of point-of-care ultrasound assessment (from March, 2019 through October, 2019; 291 cases), cases admitted after (from November, 2019 through June, 2020; 285 cases) had significantly lower in-ICU mortality (34.7% vs 26.7%, p=0.038; Fisher’s exact test), together with a dramatic change from overall positive fluid balance to negative one. Multiple logistic regression showed that cumulative fluid balance during ICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) scores on admission were independent risk factors for in-ICU mortality (p<0.001, p<0.001 and p=0.043 respectively). After controlling for APACHE II and SOFA scores on admission, Cox hazard ratio of cases with a negative cumulative fluid balance during ICU stay was 0.683 (95% confidence interval 0.475-0.981; p=0039).ConclusionsPoint-of-care ultrasound examination of internal jugular veins and inferior vena cava directed fluid therapy to conservative strategy, and negative cumulative fluid balance during ICU stay was associated with a reduced in-ICU mortality.

scholarly journals The Impact of Fluid Balances in the First 48 Hours on Mortality in the Critically Ill Patients

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Azrina Md Ralib ◽  
Norhalini Hamzah ◽  
Majdiah Syahirah Nasir ◽  
Mohd Basri Mat Nor
Keyword(s):  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Elective Surgery ◽  
Secondary Analysis ◽  
Severity Of Illness ◽  
Apache Ii Score ◽  
Positive Fluid Balance ◽  
The Impact ◽  
Cumulative Fluid Balance

Introduction: There has been increasing evidence of detrimental effects of cumulative positive fluid balance in critically ill patients. The postulated mechanism of harm is the development of interstitial oedema, with resultant increase morbidity and mortality. We aim to assess the impact of positive fluid balance within the first 48 hours on mortality in our local ICU population. Methods: This was a secondary analysis of a single centre, prospective observational study. All ICU patients more than 18 years were screened for inclusion in the study. Admission of less than 48 hours, post-elective surgery and ICU readmission were excluded. Cumulative fluid balance either as volume or percentage of body weight from admission was calculated over 6, 24 and 48 hour period from ICU admission. Results: A total of 143 patients were recruited, of these 33 died. There were higher cumulative fluid balances at 6, 24 and 48 hours in nonsurvivors compared to survivors. However, after adjusted for severity of illness, APACHE II Score, they were not predictive of mortality. Sensitivity analysis on sub-cohort of patients with acute kidney injury (AKI) showed only an actual 48-hour cumulative fluid balance was independently predictive of mortality (1.21 (1.03 to 1.42)). Conclusions: Cumulative fluid balance was not independently predictive of mortality in a heterogenous group of critically ill patients. However, in subcohort of patients with AKI, a 48-hour cumulative fluid balance was independently predictive of mortality. An additional tile is thus added to the mosaic of findings on the impact of fluid balance in a hetergenous group of critically ill patients, and in subcohort of AKI patients.

Rapid Muscle Loss Negatively Impacts Survival in Critically Ill Patients With Cirrhosis

2018 ◽  
Vol 35 (7) ◽  
pp. 663-671 ◽  
Author(s):  
Sunmi Ju ◽  
Sun Mi Choi ◽  
Young Sik Park ◽  
Chang-Hoon Lee ◽  
Sang-Min Lee ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Muscle Mass ◽  
Critically Ill Patients ◽  
Mass Change ◽  
Apache Ii Score ◽  
Muscle Loss ◽  
Icu Mortality ◽  
Skeletal Muscle Index ◽  
The Impact

Purpose: To assess the impact of rapid muscle loss before admission to intensive care unit (ICU) in critically ill patients with cirrhosis. Materials and Methods: Patients with cirrhosis who had undergone 2 or more recent computed tomography scans before admission to the medical ICU were included. Muscle cross-sectional area at the level of the third lumbar vertebra was quantified using OsiriX software. The rate of muscle mass change and skeletal muscle index (SMI) were also calculated. Multivariable Cox proportional hazards regression was used to evaluate the association between muscle loss and mortality. Results: Among 125 patients, 113 (90.4%) patients were classified as having sarcopenia. The mean body mass index was 22.6 (3.9) kg/m2. Thirty-nine (31.2%) patients were within the normal range for muscle mass change, while 86 (68.8%) patients demonstrated rapid decline in muscle mass before admission to the ICU. Patients with rapid muscle loss showed high ICU mortality (59.3%) and in-hospital mortality (77.9%). Multivariate Cox analysis showed that ICU mortality and in-hospital mortality were independently associated with malignancy, Acute Physiology and Chronic Health Evaluation (APACHE) II score, SMI, and rapid muscle loss. Conclusion: Rapid muscle decline is correlated with increased ICU mortality and in-hospital mortality in critically ill patients with cirrhosis.

scholarly journals Relation between fluid balance and incidence of morbidity and mortality rates in critically ill patients prospective observational study

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M G A Gerges ◽  
H M M Elazzazi ◽  
M H S A Elsersi ◽  
S A R Mustafa ◽  
M A Saeed
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
University Hospitals ◽  
Cumulative Fluid Balance

Abstract Background While administration of fluid can be lifesaving, it has been suggested that the fluid accumulation after initial resuscitation and hemodynamic stabilization can contribute to potentially avoidable adverse effects and less favorable outcomes. Objective The aim of this study is to assess whether positive fluid balance in comparison with negative or even fluid balance is associated with increased morbidity and mortality rates in critically ill patients. Patients and Methods This prospective observational study was performed on 145 Patients older than 18 years admitted to intensive care units at Helwan university hospitals and Ain shams university hospitals during the period from November 2017 till May 2018. Results A total of 145 patients with an ICU mortality rate of 14.5% were enrolled. The median cumulative fluid balance of the 124 patients who survive was -110 ml (IQR -2.1-2.2 L) after the fourth day following randomization while the median cumulative fluid balance of the 21 patients who not survive was 3800 ml (IQR 1.7-5.2 L) after the fourth day in ICU. In our study critically ill patients with fluid balance more than 1.2 litres per day had higher ICU complications: increased risk of AKI, longer ICU and hospital stays, and mechanical ventilation, and fluid balance was independently associated with mortality. Conclusion In the view of this study, we concluded that:Zero fluid balance and negative fluid balance independently associated with decrease mortality and morbidity rates in critically ill patients after 4 days from admission in ICU.There was higher cumulative fluid balance in non survivors compared to survivors. Cumulative fluid balance after 4 days from admission was independently predictive of mortality in a heterogeneous group of critically ill patients.96 hour negative fluid balance in critically ill patients was associated with less length of stay at ICU and less mechanical ventilation duration.Positive fluid balance, mechanical ventilation, vasopressors, and high admission SAPS II, SOFA, APACHE II and KIDGO were significantly associated with high mortality.

scholarly journals Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit

2018 ◽  
Vol 46 (3) ◽  
pp. 1254-1262 ◽  
Author(s):  
Surat Tongyoo ◽  
Tanuwong Viarasilpa ◽  
Chairat Permpikul
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Serum Potassium ◽  
Critically Ill Patients ◽  
Medical Intensive Care Unit ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Mortality ◽  
Medical Intensive Care

Objective To compare the outcomes of patients with and without a mean serum potassium (K+) level within the recommended range (3.5–4.5 mEq/L). Methods This prospective cohort study involved patients admitted to the medical intensive care unit (ICU) of Siriraj Hospital from May 2012 to February 2013. The patients’ baseline characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, serum K+ level, and hospital outcomes were recorded. Patients with a mean K+ level of 3.5 to 4.5 mEq/L and with all individual K+ values of 3.0 to 5.0 mEq/L were allocated to the normal K+ group. The remaining patients were allocated to the abnormal K+ group. Results In total, 160 patients were included. Their mean age was 59.3±18.3 years, and their mean APACHE II score was 21.8±14.0. The normal K+ group comprised 74 (46.3%) patients. The abnormal K+ group had a significantly higher mean APACHE II score, proportion of coronary artery disease, and rate of vasopressor treatment. An abnormal serum K+ level was associated with significantly higher ICU mortality and incidence of ventricular fibrillation. Conclusion Critically ill patients with abnormal K+ levels had a higher incidence of ventricular arrhythmia and ICU mortality than patients with normal K+ levels.

scholarly journals Impact of Point-of-Care Ultrasound in Critically Ill Patients

2019 ◽  
Vol 1 (9) ◽  
pp. e0042
Author(s):  
Richard Amini ◽  
Elaine Hua Situ-LaCasse ◽  
Josie Acuña ◽  
Daniel Theodoro ◽  
Michael Blaivas ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Point Of Care Ultrasound

scholarly journals A Differential Therapeutic Consideration for use of Corticosteroids According to Established COVID-19 Clinical Phenotypes in Critically Ill Patients

2021 ◽  
Author(s):  
Gerard Moreno ◽  
Manuel Ruíz- Botella ◽  
Ignacio Martin-Loeches ◽  
Josep Gómez Alvarez ◽  
María Jiménez Herrera ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Cox Proportional Hazards ◽  
High Dose ◽  
Icu Mortality ◽  
Clinical Phenotypes ◽  
Biphasic Effect ◽  
The Impact ◽  
Assumption Violation

Abstract Background: The steroids are currently used as standard treatment for severe COVID-19. However, the evidence is weak. Our aim is to determine if the use of corticosteroids was associated with Intensive Care Unit (ICU) mortality among whole population and pre-specified clinical phenotypes.Methods: A secondary analysis derived from multicenter, observational study of adult critically ill patients with confirmed COVID-19 disease admitted to 63 ICUs in Spain. Three phenotypes were derived by non-supervised clustering analysis from whole population and classified as (A: severe, B: critical and C: life-threatening). The primary outcome was ICU mortality. We performed a Multivariate analysis after propensity score full matching (PS), Cox proportional hazards (CPH), Cox covariate time interaction (TIR), Weighted Cox Regression (WCR) and Fine-Gray analysis(sHR) to assess the impact of corticosteroids on ICU mortality according to the whole population and distinctive patient clinical phenotypes. Results: A total of 2,017 patients were analyzed, 1171(58%) with corticosteroids. After PS, corticosteroids were shown not to be associated with ICU mortality (OR:1.0,95%CI:0.98-1.15). Corticosteroids were administered in 298/537(55.5%) patients of “A” phenotype and their use was not associated with ICU mortality (HR=0.85[0.55-1.33]). A total of 338/623(54.2%) patients in “B” phenotype received corticosteroids. The CPH (HR =0.65 [0.46-0.91]) and TIR regression (1- 25 day tHR=0.56[0.39-0.82] and >25 days tHR=1.53[1.03-7.12]) showed a biphasic effect of corticosteroids due to proportional assumption violation. No effect of corticosteroids on ICU mortality was observed when WCR was performed (wHR=0.72[0.49-1.05]). Finally, 535/857(62.4%) patients in “C” phenotype received corticosteroids. The CPH (HR=0.73[0.63-0.98]) and TIR regression (1- 25 day tHR=0.69[ 0.53-0.89] and >25 days tHR=1.30[ 1.14-3.25]) showed a biphasic effect of corticosteroids and proportional assumption violation. However, wHR (0.75[0.58-0.98]) and sHR (0.79[0.63-0.98]) suggest a protective effect of corticosteroids on ICU mortality. Conclusion: Our finding warns against the widespread use of corticosteroids in all critically ill patients with COVID-19 at moderate-high dose. Only patients with the highest severity could benefit from steroid treatment although this effect on clinical outcome was minimized during ICU stay.

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