Percent Fluid Overload for the Prediction of the Need for Fluid De-resuscitation in Critically Ill Patients: A Single-Centre Prospective Cohort Study

Abstract

Background: Positive fluid balance (FB) was reported in up to 40% of patients admitted to the ICU. Many studies found that positive FB is associated with increased mortality. The appropriate time for fluid de-resuscitation (DER) is controversial. This study aims to evaluate the association between percent fluid overload calculation and the need for fluid de-resuscitation among critically ill adult patients. Methods: A Prospective observational study was conducted at a single-center tertiary care hospital. The study included adult critically ill patients requiring intravenous fluid administration. Patients who were de-resuscitated with diuretics and/or renal replacement therapy were compared to those who did not require de-resuscitation. The study compared both groups for the median percent fluid accumulation on the day of fluid de-resuscitation or ICU discharge, whatever comes first. Results: Three hundred eighty-eight patients were screened between August 01, 2021, and April 30, 2022. One hundred patients were included with a mean age of 59.8 ± 16.2. The mean APACHE II score was 15.4 ±8.0. Sixty-one patients (61%) required fluid de-resuscitation, while 39 (39%) patients didn't require fluid de-resuscitation during ICU stay. Median percent fluid accumulation on the day of de-resuscitation or ICU discharge was 3.8% (1.2-8.6) and 5.3% (2.7-8.6) in patients requiring de-resuscitation and those who did not, respectively (P-value NS). Hospital mortality was found in 25 (40.9%) patients with de-resuscitation and 6 (15.3%) in those who did not require it; (P-value 0.0069). Conclusions: The median percent fluid accumulation on the day of fluid de-resuscitation or ICU discharge was not statistically different between patients who required fluid de-resuscitation and those who did not. A larger sample size is needed to confirm these findings.