Abstract
Rationale Harmful effects of cumulative positive fluid balance in critically ill patients is well described, however there is incomplete understanding of impact of early fluid accumulation in critically ill patients. We hypothesized that early positive fluid balance will adversely affect organ recovery and examined the data from the SAFE study to understand the effects of early fluid balance on recovery of organ failure in critically ill patients requiring fluid resuscitation.
Methods Data from the Saline versus Albumin Fluid Evaluation (SAFE) study were provided by The George Institute for Global Health, Australia after ethical approval. Demographic data, baseline hemodynamic data, early fluid balance (first four hours after fluid resuscitation), organ failure scores, patient related outcomes were analysed. Organ failure was examined as delta sequential organ failure scores (SOFA) at 72 hours and at baseline. Delta SOFA at 72 hours was
categorized as <-1 (improvement), -1 to 2 (equivocal) and >2 (worse). Both one way ANOVA and linear regression analysis was done to examine the effect of early fluid balance on delta SOFA at 72 hours. Data is presented as mean and standard deviation or median and interquartile range based on the distribution of the data.
Results There were 3538 patients in the dataset in whom organ failure scores were available. There was improvement in organ failure in 1232 patients (34.8%), equivocal in 1414 patients (39.9%) and worsening in 892 patients (25.2%). These
groups corresponded to an increase in early fluid balance (ml) 2338.00 (2078.52) vs 2815.02 (2081.23) vs 3152.10 (2367.06) (p<0.001). Worsening of organ failure was also associated with worsening 28 day survival in these patients [81.6% vs. 80.6% vs. 66.6%, (p<0.001)]. Factors (beta coefficient, and p value) which predicted the worsening of the organ failure were age (0.01,
p=0.012), early fluid balance (0.23, p<0.001) and admission APACHE II score (0.04, p<0.001). Similar finding were seen in patients admitted with severe sepsis.
Conclusion - Higher early fluid balance is associated with poorer recovery of the organ failure in critically ill patients requiring fluid resuscitation.
Methods Data from the Saline versus Albumin Fluid Evaluation (SAFE) study were provided by The George Institute for Global Health, Australia after ethical approval. Demographic data, baseline hemodynamic data, early fluid balance (first four hours after fluid resuscitation), organ failure scores, patient related outcomes were analysed. Organ failure was examined as delta sequential organ failure scores (SOFA) at 72 hours and at baseline. Delta SOFA at 72 hours was
categorized as <-1 (improvement), -1 to 2 (equivocal) and >2 (worse). Both one way ANOVA and linear regression analysis was done to examine the effect of early fluid balance on delta SOFA at 72 hours. Data is presented as mean and standard deviation or median and interquartile range based on the distribution of the data.
Results There were 3538 patients in the dataset in whom organ failure scores were available. There was improvement in organ failure in 1232 patients (34.8%), equivocal in 1414 patients (39.9%) and worsening in 892 patients (25.2%). These
groups corresponded to an increase in early fluid balance (ml) 2338.00 (2078.52) vs 2815.02 (2081.23) vs 3152.10 (2367.06) (p<0.001). Worsening of organ failure was also associated with worsening 28 day survival in these patients [81.6% vs. 80.6% vs. 66.6%, (p<0.001)]. Factors (beta coefficient, and p value) which predicted the worsening of the organ failure were age (0.01,
p=0.012), early fluid balance (0.23, p<0.001) and admission APACHE II score (0.04, p<0.001). Similar finding were seen in patients admitted with severe sepsis.
Conclusion - Higher early fluid balance is associated with poorer recovery of the organ failure in critically ill patients requiring fluid resuscitation.
Original language | English |
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Article number | A3621 |
Number of pages | 1 |
Journal | American Journal of Respiratory and Critical Care Medicine |
Volume | 201 |
Issue number | ATS International Conference Abstract Issue |
DOIs | |
Publication status | Published - 2020 |
Event | American Thoracic Society 2020 International Conference - Pennsylvania Convention Center, Philadelphia, United States Duration: 15 May 2020 → 20 May 2020 https://www.atsjournals.org/doi/book/10.1164/ajrccm-conference.2020 https://healthmanagement.org/c/hospital/event/american-thoracic-society-ats-conference-2020 (Conference overview) |
Keywords
- Conference abstract
- Conference poster
- American Thoracic Society
- cumulative positive fluid balance
- early fluid accumulation in critically ill patients
- Saline versus Albumin Fluid Evaluation (SAFE) study