Association between fluid overload and delirium/coma in mechanically ventilated patients
Association between fluid overload and delirium/coma in mechanically ventilated patients
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机械通气患者液体超负荷与谵妄/昏迷之间的关联
DOI：
10.1002/ams2.508
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Akira Ouchi Hideaki Sakuramoto Haruhiko Hoshino Yujiro Matsuishi Tatsuya Sakaguchi Yuki Enomoto Tetsuya Hoshino Nobutake Shimojo Yoshiaki Inoue
中科院分区：
文献类型：
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作者：
Ouchi Akira;Sakuramoto Hideaki;Unoki Takeshi;Yoshino Yasuyo;Hosino Haruhiko;Koyama Yasuaki;Enomoto Yuki;Shimojo Nobutake;Mizutani Taro;Inoue Yoshiaki;Akira Ouchi Hideaki Sakuramoto Haruhiko Hoshino Yujiro Matsuishi Tatsuya Sakaguchi Yuki Enomoto Tetsuya Hoshino Nobutake Shimojo Yoshiaki Inoue
目的几项研究表明，危重患者液体负荷（FO）与死亡率或机械通气时间之间存在关联。然而，FO与谵妄持续时间之间的关系尚不清楚。方法回顾性观察队列研究于2015年4月至2017年3月在日本筑波大学医院进行。在重症监护病房停留超过7天的机械通气患者符合纳入条件。单变量分析采用连续变量的mann - whitneu检验和分类变量的Fisher精确检验。在7天的研究期间，采用多变量比例logistic回归模型评估FO与谵妄/昏迷天数（DCDs）之间的关系。结果共纳入118例患者，分为FO组和非FO组。40%的患者出现体液超载。FO组的APACHE II评分高于非FO组（19[16-26]对23 [20-29]，P= 0.017）。FO组第3天的累积体液平衡较高（3,238[281-6,530]对7,886 [4,106-10,631]，P< 0.001）。FO组7 d内谵妄天数较长（1[0-3]比2 [1 - 3]，P= 0.048）， dcd较长（4[1 - 5]比6 [3-7]，P= 0.002）。调整协变量后，FO和dcd之间存在显著相关性（优势比为2.16；95%可信区间为1.05-4.47）。结论我们的研究结果表明，FO与机械通气患者dcd升高有关。
AimSeveral studies have shown an association between fluid overload (FO) and mortality or duration of mechanical ventilation in critically ill patients. However, the association between FO and delirium duration remains unclear.MethodsThis retrospective observational cohort study was undertaken at University of Tsukuba Hospital (Tsukuba, Japan) from April 2015 to March 2017. Mechanically ventilated patients who stayed in the intensive care unit for more than 7 days were eligible for inclusion. Univariate analysis was carried out with the Mann–WhitneyU‐test for continuous variables and Fisher’s exact test for categorical variables. A multivariate proportional odds logistic regression model was used to evaluate the association between FO and delirium/coma days (DCDs) during the 7‐day study period.ResultsA total of 118 patients were included and divided into FO and non‐FO groups. Fluid overload occurred in 40% of patients. The FO group had a higher APACHE II score than the non‐FO group (19 [16–26] versus 23 [20–29],P= 0.017). Cumulative fluid balance at day 3 was higher in the FO group (3,238 [281–6,530] versus 7,886 [4,106–10,631],P< 0.001). Delirium days within 7 days was longer in the FO group (1 [0–3] versus 2 [1–3],P= 0.048) and DCDs was longer in the FO group (4 [1–5] versus 6 [3–7],P= 0.002). After adjusting for covariates, there were significant associations between FO and DCDs (odds ratio, 2.16; 95% confidence interval, 1.05–4.47).ConclusionsOur findings suggest that FO is associated with increased DCDs in mechanically ventilated patients.