Impact of Early Fluid Balance on Long-Term Mortality in Critically Ill Surgical Patients: A Retrospective Cohort Study in Central Taiwan

Abstract

Fluid balance is an essential issue in critical care; however, the impact of early fluid balance on the long-term mortality in critically ill surgical patients remains unknown. This study aimed to address the impact of day 1–3 and day 4–7 fluid balance on the long-term mortality in critically ill surgical patients. We enrolled patients who were admitted to surgical intensive care units (ICUs) during 2015–2019 at a tertiary hospital in central Taiwan and retrieved date-of-death from the Taiwanese nationwide death registration profile. We used a Log-rank test and a multivariable Cox proportional hazards regression model to determine the independent mortality impact of early fluid balance. A total of 6978 patients were included for analyses (mean age: 60.9 ± 15.9 years; 63.9% of them were men). In-hospital mortality, 90-day mortality, 1-year and overall mortality was 10.3%, 15.8%, 23.8% and 31.7%, respectively. In a multivariable Cox proportional hazard regression model adjusted for relevant covariates, we found that positive cumulative day 4–7 fluid balance was independently associated with long-term mortality (aHR 1.083, 95% CI 1.062–1.105), and a similar trend was found on day 1–3 fluid balance, although to a lesser extent (aHR 1.027, 95% CI 1.011–1.043). In conclusion, the fluid balance in the first week of ICU stay, particularly day 4–7 fluid balance, may affect the long-term outcome in critically ill surgical patients.

Deep Learning-Based Pain Classifier Based on the Facial Expression in Critically Ill Patients

“…Given that patients in ICU often received mechanical ventilation, experienced fear were deprived of normal sleep, felt isolation; therefore, appropriate sedation, at least light sedation, is recommended as a standard of care in critically ill patients and hence leads to difficulties to identify pain based on facial expressions ( 32 ). In addition to the impact of sedation on pain assessment, subtle facial muscle movements might also be confounded by facial oedema resulting from fluid overload, which is highly prevalent in critically ill patients who underwent fluid resuscitation, as we have shown in our previous studies ( 33 , 34 ). Collectively, automated pain assessment based on facial expressions in critically ill patients is currently an unmet need in the research field of medical AI due to the aforementioned difficulties.…”

Week-One Anaemia was Associated with Increased One-Year Mortality in Critically Ill Surgical Patients

“…e TCVGH critical care data warehouse was used to retrieve data with respects to demographic data, Charlson comorbidity index (CCI), Acute Physiology and Chronic Health Evaluation (APACHE) II score, presence of shock, receiving mechanical ventilation, underwent renal replacement, management including blood transfusion, and laboratory data [10]. Previous studies, including our studies, have shown the mortality association of early (day 1-3) overall fluid balance status and culture positivity of microbial culture during ICU admission, we hence included these two variables as covariates in the present study [11][12][13].…”