Characterisation of fluid balance over time: preliminary results from the Role of Active Deresuscitation After Resuscitation (RADAR) study.
CCCF ePoster library. Silversides J. Oct 27, 2015; 117340; P54 Disclosure(s): None.
Dr. Jon Silversides
Dr. Jon Silversides
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Abstract
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Introduction
Widespread uncertainty surrounds the benefits and harms of fluid administration in critical illness [1, 2]. An association between fluid accumulation and mortality in critically ill patients is well known [3, 4], however the degree to which this reflects variation in clinical practice rather than residual confounding by a greater volume of fluid being given to more severely ill patients is unclear.

Objectives
We aimed to characterise patterns of fluid intake, output and net balance over time and the relative contributions of administered intravenous fluid boluses, maintenance fluids, nutrition, medication volumes and other fluid sources.

Methods
We undertook a cohort study of adult ICU patients who received mechanical ventilation for more than 24 hours. We excluded patients with sub-arachnoid haemorrhage, drug overdose or diabetic ketoacidosis. We collected data on demographics, diagnosis, physiological status and daily fluid intake and output throughout ICU admission.

We compared the characteristics of survivors and non-survivors at 30 days following ICU admission using Pearson’s chi-squared test for categorical variables and Student’s t-test for continuous variables, or a non-parametric equivalent where appropriate. Analysis of variance was used to compare continuous variables between multiple groups.

Results
300 patients from 7 ICUs in the United Kingdom were included (174 male, mean age 62.5 years, mean APACHE II score 18.0), of whom 94 were deceased at 30 days post-ICU admission (31.3%). Cumulative fluid balance increased over time up to day 3 and remained constant thereafter (Figure 1).

In univariate analysis, age, APACHE II score, patient type, markers of organ dysfunction (PaO2/FiO2 ratio, serum lactate and RRT use) and cumulative fluid balance were associated with 30-day mortality (Table 1).

We compared survivors and non-survivors with regard to fluid balance at alternative time points (after 3 and 5 days in ICU both including and excluding the day 1 fluid balance): a significant difference in fluid balance was present after day 3 and after day 3 with day 1 fluid balance excluded.

Sources of administered fluid by study site are depicted in Graph 2. Mean volumes of maintenance fluid and bolus fluid administered over days 1 to 3 differed signficantly between sites (P<0.0001 and P=0.015 respectively).

Conclusions
A persistent positive cumulative fluid balance was common and multifactorial in origin. Considerable practice variation in fluid administration was present and may account for some of the variability in cumulative fluid balance.


References
1. Hilton AK, Bellomo R: Totem and taboo: fluids in sepsis. Crit Care 2011, 15:164.
2. Edwards MR, Mythen MG: Fluid therapy in critical illness. Extrem Physiol Med, 2014:1–9.
3. Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall J-R, Payen D, 'Sepsis Occurrence in Acutely Ill Patients' Investigators: Sepsis in European intensive care units: results of the SOAP study. Critical Care Medicine 2006, 34:344–353.
4. Boyd JH, Forbes J, Nakada T-A, Walley KR, Russell JA: Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med 2011, 39:259–265.
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