Positive fluid balance is associated with reduced survival in critically ill patients with cancer

Almeida, Juliano Pinheiro de; Palomba, Henrique; Galas, Filomena Regina Barbosa Gomes; Fukushima, Júlia Tizue; Duarte, Fernando Aires; Nagaoka, Danielle; Torres, Viviane Bogado Leite; Yu, Liang; Vincent, Jean‐Louis; Auler, José Otávio Costa; Hajjar, Ludhmila Abrahão

doi:10.1111/j.1399-6576.2012.02717.x

Cited by 43 publications

(31 citation statements)

References 25 publications

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“…Although the initial resuscitation period after trauma has been extensively studied and has shown that administration of large volumes has detrimental effects on mortality and development of complications including coagulopathy and abdominal compartment syndrome [3,[11][12][13][20][21][22][23], very little is known about the effect of the FB status over the course of the surgical ICU stay. In our study, the percentage of trauma patients was equally divided between the FB (−) and FB (+) groups, and the aforementioned outcomes related to mortality and complications may apply to this subgroup of patients, too.…”

Section: Discussionmentioning

confidence: 99%

Impact of positive fluid balance on critically ill surgical patients: A prospective observational study

Barmparas

Liou

Lee

et al. 2014

Journal of Critical Care

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Section: Discussionmentioning

confidence: 99%

Impact of positive fluid balance on critically ill surgical patients: A prospective observational study

Barmparas

Liou

Lee

et al. 2014

Journal of Critical Care

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“…Patients with subarachnoid hemorrhage and positive fluid balance were more likely to prolonged hospital LOS (24). In cancer patients, a cumulative positive fluid balance was independently associated with morality (25). Another study found that accumulative fluid balance from the second and third ICU days and total ICU stay fluid balance were positively associated with hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

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

Kelm

Perrin²,

Cartin‐Ceba

et al. 2015

Shock

302

189

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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.

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“…In critically ill septic and non-septic patients, the cumulative positive fluid balance has been associated with a worse outcome [29-31,34,36,37], and the administration of catecholamines, particularly at higher doses, was associated with derangements in regional blood flow [7,8], adverse side effects [33,35] and increased likelihood of death [15,32,35]. In our experimental model such effects were not observed or observable.…”

Section: Discussionmentioning

confidence: 99%

Increasing mean arterial blood pressure in sepsis: effects on fluid balance, vasopressor load and renal function

et al. 2013

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IntroductionThe objective of this study was to evaluate the effects of two different mean arterial blood pressure (MAP) targets on needs for resuscitation, organ dysfunction, mitochondrial respiration and inflammatory response in a long-term model of fecal peritonitis.MethodsTwenty-four anesthetized and mechanically ventilated pigs were randomly assigned (n = 8/group) to a septic control group (septic-CG) without resuscitation until death or one of two groups with resuscitation performed after 12 hours of untreated sepsis for 48 hours, targeting MAP 50-60 mmHg (low-MAP) or 75-85 mmHg (high-MAP).ResultsMAP at the end of resuscitation was 56 ± 13 mmHg (mean ± SD) and 76 ± 17 mmHg respectively, for low-MAP and high-MAP groups. One animal each in high- and low-MAP groups, and all animals in septic-CG died (median survival time: 21.8 hours, inter-quartile range: 16.3-27.5 hours). Norepinephrine was administered to all animals of the high-MAP group (0.38 (0.21-0.56) mcg/kg/min), and to three animals of the low-MAP group (0.00 (0.00-0.25) mcg/kg/min; P = 0.009). The high-MAP group had a more positive fluid balance (3.3 ± 1.0 mL/kg/h vs. 2.3 ± 0.7 mL/kg/h; P = 0.001). Inflammatory markers, skeletal muscle ATP content and hemodynamics other than MAP did not differ between low- and high-MAP groups. The incidence of acute kidney injury (AKI) after 12 hours of untreated sepsis was, respectively for low- and high-MAP groups, 50% (4/8) and 38% (3/8), and in the end of the study 57% (4/7) and 0% (P = 0.026). In septic-CG, maximal isolated skeletal muscle mitochondrial Complex I, State 3 respiration increased from 1357 ± 149 pmol/s/mg to 1822 ± 385 pmol/s/mg, (P = 0.020). In high- and low-MAP groups, permeabilized skeletal muscle fibers Complex IV-state 3 respiration increased during resuscitation (P = 0.003).ConclusionsThe MAP targets during resuscitation did not alter the inflammatory response, nor affected skeletal muscle ATP content and mitochondrial respiration. While targeting a lower MAP was associated with increased incidence of AKI, targeting a higher MAP resulted in increased net positive fluid balance and vasopressor load during resuscitation. The long-term effects of different MAP targets need to be evaluated in further studies.

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Positive fluid balance is associated with reduced survival in critically ill patients with cancer

Cited by 43 publications

References 25 publications

Impact of positive fluid balance on critically ill surgical patients: A prospective observational study

Impact of positive fluid balance on critically ill surgical patients: A prospective observational study

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

Increasing mean arterial blood pressure in sepsis: effects on fluid balance, vasopressor load and renal function

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