Fluid management in ARDS: an evaluation of current practice and the association between early diuretic use and hospital mortality.
Fluid management in ARDS: an evaluation of current practice and the association between early diuretic use and hospital mortality.
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DOI：
10.1186/s40560-020-00496-7
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发表时间：
2020
影响因子：
7.1
通讯作者：
Hough CL
中科院分区：
文献类型：
--
作者：
Seitz KP;Caldwell ES;Hough CL
急性呼吸窘迫综合征（ARDS）和容量超负荷与住院死亡率增加有关。有证据支持ARDS的保守液体管理，但目前的实践是否反映了该证据的实施尚未得到描述。本研究报告了ICU ARDS患者当代液体管理的变化。我们比较了常规护理和试验方案，并分析了在当代常规护理中使用利尿药物的保守治疗是否与结局相关。我们在2016年和2017年期间在两家学术医院的9个ICU中进行了回顾性队列研究。我们纳入了234例符合中重度ARDS标准（PaO 2：FIO 2 ≤ 150）后至少3天入住ICU的成人ARDS患者。主要暴露是在符合ARDS标准后48至72小时内使用任何利尿剂。主要结局为住院死亡率。采用未校正的统计分析和多变量logistic回归分析。在符合ARDS标准后48-72 h内，116例患者（50%）接受了利尿剂治疗。接受利尿剂治疗组的住院死亡率低于未接受利尿剂治疗组（14% vs 25%; p = 0.025）。在ARDS发作时，两组的序贯器官衰竭评估评分和ICU液体平衡相似。在ARDS后的前48小时内，利尿剂组接受的晶体液少于无利尿剂组（中位数[四分位数间距]：1.2 L [0.2-2.8] vs 2.4 L [1.2-5.0]; p < 0.001），但两组接受的药物和营养液多于晶体液。48 h时，各组中容量超负荷（ICU液体平衡>体重的10%）的发生率分别为16%和25%（p = 0.09）。在ARDS后48-72小时内，休克的总体发生率为44%，两组相似。仅18%的患者记录到中心静脉压。调整混杂因素后，早期使用利尿剂与较低的住院死亡率独立相关（AOR 0.46，95%CI [0.22，0.96]）。在这个样本的ARDS患者中，容量超负荷是常见的，早期使用利尿剂与较低的住院死亡率独立相关。这些发现支持了液体管理在ARDS中的重要性，并为进一步研究和实施保守的液体策略提供了机会。
Acute respiratory distress syndrome (ARDS) and volume overload are associated with increased hospital mortality. Evidence supports conservative fluid management in ARDS, but whether current practice reflects the implementation of that evidence has not been described. This study reports the variability in contemporary fluid management for ICU patients with ARDS. We compared routine care to trial protocols and analyzed whether more conservative management with diuretic medications in contemporary, usual care is associated with outcomes. We performed a retrospective cohort study in nine ICUs at two academic hospitals during 2016 and 2017. We included 234 adult patients with ARDS in an ICU at least 3 days after meeting moderate-severe ARDS criteria (PaO2:FIO2 ≤ 150). The primary exposure was any diuretic use in 48 to 72 h after meeting ARDS criteria. The primary outcome was hospital mortality. Unadjusted statistical analyses and multivariable logistic regression were used. In 48–72 h after meeting ARDS criteria, 116 patients (50%) received a diuretic. In-hospital mortality was lower in the group that received diuretics than in the group that did not (14% vs 25%; p = 0.025). At ARDS onset, both groups had similar Sequential Organ Failure Assessment scores and ICU fluid balances. During the first 48 h after ARDS, the diuretic group received less crystalloid fluid than the no diuretic group (median [inter-quartile range]: 1.2 L [0.2–2.8] vs 2.4 L [1.2-5.0]; p < 0.001), but both groups received more fluid from medications and nutrition than from crystalloid. At 48 h, the prevalence of volume overload (ICU fluid balance >10% of body weight) in each group was 16% and 25%(p = 0.09), respectively. During 48–72 h after ARDS, the overall prevalence of shock was 44% and similar across both groups. Central venous pressure was recorded in only 18% of patients. Adjusting for confounders, early diuretic use was independently associated with lower hospital mortality (AOR 0.46, 95%CI [0.22, 0.96]). In this sample of ARDS patients, volume overload was common, and early diuretic use was independently associated with lower hospital mortality. These findings support the importance of fluid management in ARDS and suggest opportunities for further study and implementation of conservative fluid strategies into usual care.
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DOI：
10.1097/shk.0000000000000268
发表时间：
2015-01
期刊：
Shock (Augusta, Ga.)
影响因子：
--
作者：
Kelm DJ;Perrin JT;Cartin-Ceba R;Gajic O;Schenck L;Kennedy CC
通讯作者：
Kennedy CC
影响因子：
8.8
作者：
Grissom CK;Hirshberg EL;Dickerson JB;Brown SM;Lanspa MJ;Liu KD;Schoenfeld D;Tidswell M;Hite RD;Rock P;Miller RR 3rd;Morris AH;National Heart Lung and Blood Institute Acute Respiratory Distress Syndrome Clinical Trials Network
通讯作者：
National Heart Lung and Blood Institute Acute Respiratory Distress Syndrome Clinical Trials Network
DOI：
10.1164/rccm.201603-0645oc
发表时间：
2017-02-01
影响因子：
24.7
作者：
Famous, Katie R.;Delucchi, Kevin;Calfee, Carolyn S.
通讯作者：
Calfee, Carolyn S.
影响因子：
2.7
作者：
O'Connor, Michael E;Jones, Sarah L;Prowle, John R
通讯作者：
Prowle, John R
影响因子：
19.6
作者：
Bouchard, Josee;Soroko, Sharon B.;Mehta, Ravindra L.
通讯作者：
Mehta, Ravindra L.