Fluid overload in patients with severe sepsis and septic shock treated with early goal-directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death.
Fluid overload in patients with severe sepsis and septic shock treated with early goal-directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death.
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DOI：
10.1097/shk.0000000000000268
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发表时间：
2015-01
期刊：
影响因子：
--
通讯作者：
Kennedy CC
中科院分区：
文献类型：
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作者：
Kelm DJ;Perrin JT;Cartin-Ceba R;Gajic O;Schenck L;Kennedy CC
早期目标导向治疗（EGDT）包括早期、积极的液体复苏，已知可提高败血症患者的生存率。目前尚不清楚EGDT导致后续体液超载的频率，以及EGDT后体液超载是否会影响患者的预后。我们的假设是，接受EGDT治疗的脓毒症患者存在体液超载的风险，而体液超载与不良结果相关。我们对2008年1月至2009年12月在一家三级专科医院重症监护室连续收治的405例严重脓毒症和感染性休克患者进行了回顾性队列研究。对基线人口统计学、每日体重、体液状况、体液超载的临床或影像学证据以及医疗干预（胸腔穿刺、射膜穿刺、利尿剂使用和超滤）进行了抽象，并利用单因素和多因素logistic和线性回归分析探讨了相关关系。在第1天，67%的患者出现体液超载的迹象，48%的患者体液超载持续到第三天。评分者之间对于流体过载存在的一致性是显著的（kappa=0.7）。体重增加的趋势在那些持续的临床和放射证据的液体超载，但没有记录的阳性液体平衡。根据基线疾病严重程度进行调整后，液体超载与液体相关医疗干预（胸腔穿刺和利尿剂）的使用增加和住院死亡率相关（OR 1.92[1.16-3.22]）。在接受EGDT治疗的严重脓毒症和脓毒性休克患者中，持续体液超载的临床证据很常见，并与医疗干预的使用增加和住院死亡率相关。
Early-goal-directed therapy (EGDT) consists of early, aggressive fluid resuscitation and is known to improve survival in sepsis. It is unknown how often EGDT leads to subsequent fluid overload and whether post-EGDT fluid overload affects patients’ outcomes. Our hypothesis was that septic patients treated with EGDT were at risk for fluid overload and that fluid overload would be associated with adverse outcomes. We conducted a retrospective cohort of 405 consecutive patients admitted with severe sepsis and septic shock to the medical intensive care unit of a tertiary care academic hospital from January 2008 to December 2009. Baseline demographics, daily weights, fluid status, clinical or radiographic evidence of fluid overload, and medical interventions (thoracentesis, paracentesis, diuretic use, and ultrafiltration) were abstracted and associations explored using univariate and multivariate logistic and linear regression analyses. At day 1, 67% of patients developed evidence of fluid overload and in 48% fluid overload persisted to day three. Inter-rater agreement for presence of fluid overload was substantial (kappa=0.7). An increased trend in weight was noted in those with persistent clinical and radiologic evidence of fluid overload, but not with recorded positive fluid balance. When adjusted for baseline severity of illness, fluid overload was associated with increased use of fluid-related medical interventions (thoracentesis and diuretics) and hospital mortality (OR 1.92 [1.16-3.22]). In patients with severe sepsis and septic shock treated with EGDT, clinical evidence of persistent fluid overload is common and is associated with increased use of medical interventions and hospital mortality.