Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov;24(11):1028-1036.
doi: 10.5005/jp-journals-10071-23653.

A Prospective Observational Study of Rational Fluid Therapy in Asian Intensive Care Units: Another Puzzle Piece in Fluid Therapy

Matthias Jacob  1 , Sambit Sahu  2 , Yogendra P Singh  3 , Yatin Mehta  4 , Kuang-Yao Yang  5 , Shuenn-Wen Kuo  6 , Farooq Memom  7 , Shirish Prayag  8 , Rajesh Pande  9 , Nirmal Jaiswal  10 , Tan C Cheng  11 , Amit Mandal  12 , Shanti R Deva  13 , Mohan Mathew  14 , Nagarajan Ramakrishnan  15 , Vineya Rai  16 , Luah Wah  17 , Gopinath Ramachandran  18 , Rajesh Chawla  19 , Z A Khan  20 , J V Divatia  21 , Rajesh Mishra  22 , Pravin Amin  23 , Jayant Shelgaokar  24 , Bernhard Zwissler  25 , Hugo Van Aken  26 , Christian Ertmer  26
Affiliations

A Prospective Observational Study of Rational Fluid Therapy in Asian Intensive Care Units: Another Puzzle Piece in Fluid Therapy

Matthias Jacob et al. Indian J Crit Care Med. 2020 Nov.

Abstract

Introduction: Fluid therapy in critically ill patients, especially timing and fluid choice, is controversial. Previous randomized trials produced conflicting results. This observational study evaluated the effect of colloid use on 90-day mortality and acute kidney injury (RIFLE F) within the Rational Fluid Therapy in Asia (RaFTA) registry in intensive care units.

Materials and methods: RaFTA is a prospective, observational study in Asian intensive care unit (ICU) patients focusing on fluid therapy and related outcomes. Logistic regression was performed to identify risk factors for increased 90-day mortality and acute kidney injury (AKI).

Results: Twenty-four study centers joined the RaFTA registry and collected 3,187 patient data sets from November 2011 to September 2012. A follow-up was done 90 days after ICU admission. For 90-day mortality, significant risk factors in the overall population were sepsis at admission (OR 2.185 [1.799; 2.654], p < 0.001), cumulative fluid balance (OR 1.032 [1.018; 1.047], p < 0.001), and the use of vasopressors (OR 3.409 [2.694; 4.312], p < 0.001). The use of colloids was associated with a reduced risk of 90-day mortality (OR 0.655 [0.478; 0.900], p = 0.009). The initial colloid dose was not associated with an increased risk for AKI (OR 1.094 [0.754; 1.588], p = 0.635).

Conclusion: RaFTA adds the important finding that colloid use was not associated with increased 90-day mortality or AKI after adjustment for baseline patient condition.

Clinical significance: Early resuscitation with colloids showed potential mortality benefit in the present analysis. Elucidating these findings may be an approach for future research.

How to cite this article: Jacob M, Sahu S, Singh YP, Mehta Y, Yang K-Y, Kuo S-W, et al. A Prospective Observational Study of Rational Fluid Therapy in Asian Intensive Care Units: Another Puzzle Piece in Fluid Therapy. Indian J Crit Care Med 2020;24(11):1028-1036.

Keywords: Acute kidney injury; Colloids; Critical illness; Crystalloids; Fluid therapy; Hydroxyethyl starch.

PubMed Disclaimer

Conflict of interest statement

Source of support: Fresenius Kabi supported data collection with an unrestricted grant. Conflict of interest: None

Figures

Flowchart 1
Flowchart 1
Patient flow
Figs 1A and B
Figs 1A and B
(A) Mean colloid dose (red line) + standard deviation (blue line) and the number of patients receiving colloids; (B) Percentages of patients receiving colloids and different types of colloids. SD, standard deviation; HES, hydroxyethyl starch
Fig. 2
Fig. 2
Odds ratios for 90-day mortality in the total study population and national subgroups in a best/worst-case scenario [all patients with missing mortality data were taken into account as dead (red) or alive (green) during 90-day follow-up]
Fig. 3
Fig. 3
Odds ratios of a logistic regression model for 90-day mortality in all patients. The number of patients for these subgroups is 2,471; 2,157; 2,282; 1,828. All subgroups include patients receiving no colloids or those receiving colloids on the indicated day(s). TISS, therapeutic intervention scoring system
See this image and copyright information in PMC

References

    1. Reinhart K, Perner A, Sprung CL, Jaeschke R, Schortgen F, Johan Groeneveld AB, et al. Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients. Intensive Care Med. 2012;38(3):368–383. - PubMed
    1. Zacharowski K, Aken H, Marx G, Jacob M, Schaffartzik W, Zenz M, et al. Comments on Reinhart Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients. Intensive Care Med. 2012;38(9):1556–1557. - PMC - PubMed
    1. Meybohm P, Aken H, Gasperi A, Hert S, Rocca G, Girbes ARJ, et al. Re-evaluating currently available data and suggestions for planning randomised controlled studies regarding the use of hydroxyethyl starch in critically ill patients - a multidisciplinary statement. Crit Care. 2013;17(4):R166. - PMC - PubMed
    1. Coriat P, Guidet B, Hert S, de, Kochs E, Kozek S, van Aken H. Counter statement to open letter to the executive director of the european medicines agency concerning the licensing of hydroxyethyl starch solutions for fluid resuscitation. Br J Anaesth. 2014;113(1):194–195. - PubMed
    1. Myburgh JA. Fluid resuscitation in acute medicine: what is the current situation? J Intern Med. 2015;277(1):58–68. - PubMed

LinkOut - more resources