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.

scholarly journals Mid-regional pro-adrenomedullin (MR-proADM), a marker of positive fluid balance in critically ill patients: results of the ENVOL study

Critical Care ◽  
2016 ◽  
Vol 20 (1) ◽  
Author(s):  
Bernard Vigué ◽  
Pierre-Etienne Leblanc ◽  
Frédérique Moati ◽  
Eric Pussard ◽  
Hussam Foufa ◽  
...  
Keyword(s):  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Positive Fluid Balance

Positive fluid balance is associated with reduced survival in critically ill patients with cancer

2012 ◽  
Vol 56 (6) ◽  
pp. 712-717 ◽  
Author(s):  
J. P. ALMEIDA ◽  
H. PALOMBA ◽  
F. R. B. G. GALAS ◽  
J. T. FUKUSHIMA ◽  
F. A. DUARTE ◽  
...  
Keyword(s):  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Positive Fluid Balance ◽  
Patients With Cancer

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 Evaluation of low-dose aspirin use among COVID-19 critically ill patients: A Multicenter Propensity Score Matched Study

2021 ◽  
Author(s):  
Abdullah Al Harthi ◽  
Khalid Al Sulaiman ◽  
Ohoud Aljuhani ◽  
Ghazwa B. Korayem ◽  
Ali F. Altebainawi ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose ◽  
P Value ◽  
Icu Stay ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Anti Inflammatory

Abstract BackgroundMultiple medications with anti-inflammatory effects have been used to manage the hyper-inflammatory response associated with COVID-19. Aspirin is used widely as a cardioprotective agent due to its antiplatelet and anti-inflammatory properties. Its role in hospitalized COVID-19 patients has been assessed and evaluated in the literature. However, no data regards its role in COVID-19 critically ill patients. Therefore, this study aims to evaluate the use of low-dose aspirin (81-100 mg) and its impact on outcomes in COVID-19 critically ill patients. MethodThis is a multicenter, retrospective cohort study for all adult critically ill patients with confirmed COVID-19 admitted to Intensive Care Units (ICUs) between March 1, 2020, and March 31, 2021. Eligible patients were classified into two groups based on aspirin use during ICU stay. The primary outcome is the in-hospital mortality; other outcomes were considered secondary. Propensity score-matched used based on patient’s age, SOFA score, MV status within 24 hours of ICU admission, prone position status, ischemic heart disease (IHD), and stroke as co-existing illness. We considered a P value of < 0.05 statistically significant.ResultsA total of 1033 patients were eligible; 352 patients were included after propensity score matching (1:1 ratio). The in-hospital mortality (HR (95%CI): 0.73 (0.56, 0.97), p-value=0.03) were lower in patients who received aspirin during hospital stay. On the other hand, patients who received aspirin have a higher risk of major bleeding compared to the control group (OR (95%CI): 2.92 (0.91, 9.36), p-value=0.07); but was not statistically significant.ConclusionAspirin use in COVID-19 critically ill patients may have a mortality benefit; nevertheless, it may be linked with an increased risk of significant bleeding. The benefit-risk evaluation for aspirin usage during an ICU stay should be tailored to each patient.

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 The effect of scenario based teaching for critical care nurses and physicians on their knowledge of fluid creep

2018 ◽  
Vol 9 (4) ◽  
pp. 86
Author(s):  
Ghada Shalaby Khalaf Mahran ◽  
Asmaa Ali Mahgoub ◽  
Mostafa Samy Abass
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Fluid Resuscitation ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Critical Care Nurses ◽  
University Hospital ◽  
P Value ◽  
Nurses And Physicians

Introduction: Fluid resuscitation is a major component of the acute management of critically ill patients. The phenomenon of providing excessive fluid resuscitation volumes has been termed “fluid creep”. Today, the science of nursing becomes more complex. Accurate fluid balance assessment and recording is important component of nursing care that assures patient’s safety especially in critically ill patients. The aim of the work is to examine the effect of scenario based teaching for critical care nurses and physicians on their knowledge of fluid balance & fluid creep.Methods: The study design: pre & posttest research design. Setting: This study was implemented in general, trauma, obstetric and burn intensive care units (ICUs) at Assiut university Hospital-Assiut-Egypt. Subjects: 35 critical care nurses and 29 intensive care physicians were drawn from the previously mentioned ICUs. Methodology: A pre & posttest questionnaire of nurses’ and physicians’ knowledge, perception and satisfaction regarding fluid creep and fluid balance was adapted from the articles and was used in data collection before and after the application of scenario based teaching. This questionnaire was implemented on two phases (pre and after the teaching program). The data was collected from January 2018 to July 2018.Results: There is a considerable improvement in participants’ knowledge and perception concerning fluid balance and fluid creep after applying the scenario based teaching (p value < .001).Conclusions: Nowadays, nurses and physicians need advanced level of knowledge to be able to deal with the physiological changes that occur in critically ill.

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.

Impact of loop diuretics on critically ill patients with a positive fluid balance

Anaesthesia ◽  
2020 ◽  
Vol 75 (S1) ◽  
Author(s):  
A. B. Libório ◽  
M. L. Barbosa ◽  
V. B. Sá ◽  
T. T. Leite
Keyword(s):  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Loop Diuretics ◽  
Positive Fluid Balance

scholarly journals Clinical Outcomes and Independent Risk Factors for 90-day Mortality in Critically-ill Patients Infected with SARS CoV-2: A Multicenter Study in Turkish Intensive Care Units

2021 ◽  
Author(s):  
Kursat Gundogan ◽  
Ismail Hakki Akbudak ◽  
Pervin Hanci ◽  
Burcin Halacli ◽  
Sahin Temel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critically Ill ◽  
Cardiac Arrhythmia ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Lactate Level ◽  
Invasive Mechanical Ventilation ◽  
Positive Fluid Balance

Abstract PurposeThere are limited data on long-term outcome of COVID-19 from different parts of the world. The aim of this study was to determine risk factors of 90-day mortality in critically-ill patients infected with SARS-CoV-2 in Turkish ICUs. MethodsPatients with COVID-19 from26 ICUs in Turkey were included in the study. Demographics, clinical characteristics, laboratory variables, treatment, and survival data were recorded. ResultsA total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. 90-day mortality rate was 55.1%. Factors independently associated with 90-day mortality were invasive mechanical ventilation (HR 4.09 [95% CI: 2.20-7.63]), lactate level > 2 mmol/L (2.78 [1.93-4.01]), age ≥ 60 years (2.45 [1.48-4.06)]), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20]), vasopressor treatment (1.94 [1.32-2.84]), positive fluid balance of ≥ 600 ml/per day (1.68 [1.21-2.34]), PaO2/FiO2 ratio of ≤ 150 mmHg (1.66 [1.18-2.32], and ECOG score ≥ 1 (1.42 [1.00-2.02]. ConclusionThis study has shown that long-term mortality was high in critically-ill COVID-19 patients in Turkish ICUs. Invasive mechanical ventilation, high lactate level, older age, presence of cardiac arrhythmia, need for vasopressor treatment, positive fluid balance, severe hypoxemia and not having fully-active performance were related with mortality.

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