Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units.
Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units.
复制标题
DOI：
10.1186/cc9293
复制
发表时间：
2010
期刊：
影响因子：
--
通讯作者：
SAFE TRIPS Investigators
中科院分区：
文献类型：
--
作者：
Finfer S;Liu B;Taylor C;Bellomo R;Billot L;Cook D;Du B;McArthur C;Myburgh J;SAFE TRIPS Investigators
最近的证据表明，用于复苏的液体的选择可能会影响危重患者的死亡率。我们在25个国家的391个重症监护病房进行了一项横断面研究，以描述在复苏期间给予的液体类型。我们使用广义估计方程来检验患者、处方者、地理因素和所用液体的类型(分类为晶体、胶体或血液产品)之间的关联。在24小时的研究期间，5,274名患者中有1,955名(37.1%)在4,488次复苏过程中接受了复苏液体。应用晶体或胶体的主要适应症是血流灌注受损(1526/3419(44.6%))或纠正异常生命体征(1189/3419(34.8%))。总体而言，使用胶体的患者更多(1,234人(23.4%)比782人(14.8%))，发作次数(2,173人(48.4%)比1,468人(32.7%))。在对患者和处方者的特点进行调整后，不同国家之间的做法差异很大，因为国家是开出的液体类型的强烈独立决定因素。与加拿大(35.5%、40.6%和28.3%)相比，中国、英国和新西兰使用晶体处方的优势比分别为0.46(95%可信区间0.30~0.69)、0.18(0.10~0.32)和3.43(1.71~6.84)；中国、英国和新西兰使用胶体处方的优势比分别为1.72(1.2 0~2.47)、4.72(2.99~7.44)和0.39(0.2 1~0.74)。相比之下，液体的选择不受疾病严重程度衡量标准(例如，急性生理学和慢性健康评估(APACHE)II评分)的影响。输注复苏液体是重症监护室的常见干预措施，不同国家的液体选择有很大不同。虽然胶体溶液更昂贵，而且可能对某些患者有害，但与晶体溶液相比，它们在更多的患者身上使用，在更多的复苏期间使用。
Recent evidence suggests that choice of fluid used for resuscitation may influence mortality in critically ill patients. We conducted a cross-sectional study in 391 intensive care units across 25 countries to describe the types of fluids administered during resuscitation episodes. We used generalized estimating equations to examine the association between patient, prescriber and geographic factors and the type of fluid administered (classified as crystalloid, colloid or blood products). During the 24-hour study period, 1,955 of 5,274 (37.1%) patients received resuscitation fluid during 4,488 resuscitation episodes. The main indications for administering crystalloid or colloid were impaired perfusion (1,526/3,419 (44.6%) of episodes), or to correct abnormal vital signs (1,189/3,419 (34.8%)). Overall, colloid was administered to more patients (1,234 (23.4%) versus 782 (14.8%)) and during more episodes (2,173 (48.4%) versus 1,468 (32.7%)) than crystalloid. After adjusting for patient and prescriber characteristics, practice varied significantly between countries with country being a strong independent determinant of the type of fluid prescribed. Compared to Canada where crystalloid, colloid and blood products were administered in 35.5%, 40.6% and 28.3% of resuscitation episodes respectively, odds ratios for the prescription of crystalloid in China, Great Britain and New Zealand were 0.46 (95% confidence interval (CI) 0.30 to 0.69), 0.18 (0.10 to 0.32) and 3.43 (1.71 to 6.84) respectively; odds ratios for the prescription of colloid in China, Great Britain and New Zealand were 1.72 (1.20 to 2.47), 4.72 (2.99 to 7.44) and 0.39 (0.21 to 0.74) respectively. In contrast, choice of fluid was not influenced by measures of illness severity (for example, Acute Physiology and Chronic Health Evaluation (APACHE) II score). Administration of resuscitation fluid is a common intervention in intensive care units and choice of fluid varies markedly between countries. Although colloid solutions are more expensive and may possibly be harmful in some patients, they were administered to more patients and during more resuscitation episodes than crystalloids were.
登录
查看更多内容
影响因子：
158.5
作者：
Rivers, E;Nguyen, B;Tomlanovich, M
通讯作者：
Tomlanovich, M
影响因子：
8.8
作者：
Vincent, JL;de Mendonca, A;Blecher, S
通讯作者：
Blecher, S
影响因子：
38.9
作者：
Schortgen, Frederique;Girou, Emmanuelle;Brochard, Laurent
通讯作者：
Brochard, Laurent
影响因子：
38.9
作者：
Boldt, J;Lenz, M;Papsdorf, M
通讯作者：
Papsdorf, M
影响因子：
38.9
作者：
Miletin, MS;Stewart, TE;Norton, PG
通讯作者：
Norton, PG