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. 2015 Dec;30(6):1338-43.
doi: 10.1016/j.jcrc.2015.07.009. Epub 2015 Jul 16.

Impact of late fluid balance on clinical outcomes in the critically ill surgical and trauma population

Kathryn A Elofson  1 , Daniel S Eiferman  1 , Kyle Porter  1 , Claire V Murphy  2
Affiliations

Impact of late fluid balance on clinical outcomes in the critically ill surgical and trauma population

Kathryn A Elofson et al. J Crit Care. 2015 Dec.

Abstract

Purpose: Management of fluid status in critically ill patients poses a significant challenge due to limited literature. This study aimed to determine the impact of late fluid balance management after initial adequate fluid resuscitation on in-hospital mortality for critically ill surgical and trauma patients.

Materials and methods: This single-center retrospective cohort study included 197 patients who underwent surgical procedure within 24 hours of surgical intensive care unit admission. Patients with high fluid balance on postoperative day 7 (>5 L) were compared with those with a low fluid balance (≤5 L) with a primary end point of in-hospital mortality. Subgroup analyses were performed based on diuretic administration, diuretic response, and type of surgery.

Results: High fluid balance was associated with significantly higher in-hospital mortality (30.2 vs 3%, P<.001) compared with low fluid balance; this relationship remained after multivariable regression analysis. High fluid balance was associated with increased mortality, independent of diuretic administration, diuretic response, and type of surgery.

Conclusions: Consistent with previous literature, high fluid balance on postoperative day 7 was associated with increased in-hospital mortality. Patients who received and responded to diuretic therapy did not demonstrate improved clinical outcomes, which questions their use in the postoperative period.

Keywords: Critical illness; Diuretics; Fluid balance; Fluid therapy; General surgery; Postoperative period.

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Figures

Figure 1
Figure 1
Development of Study Cohort
Figure 2
Figure 2
Daily Fluid Balance Based of Survivors vs Non-Survivors through Post-Operative Day 7
Figure 3
Figure 3
Cumulative Balance Based of Survivors vs Non-Survivors through Post-Operative Day 7
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