The importance of fluid balance in critically ill patients: a retrospective observational study

Abstract

BACKGROUND Fluid therapy in critically ill patients remains one of the most demanding and difficult aspects of care. This is particularly important in patients admitted to the intensive care unit (ICU) due to cardiovascular disorders. AIMS The aim of this study was to investigate whether a cumulative fluid balance (FB) affects mortality in critically ill patients hospitalized at the ICU. METHODS Data were obtained from the medical records of the ICU at the Silesian Centre for Heart Diseases. All patients admitted to the ICU between 2012 and 2016 were evaluated. Patients who died or were discharged from the ICU within 48 hours from admission were excluded. Fluid balance and the type of fluids infused during the first 7 days were assessed. The primary outcome was ICU mortality. RESULTS Overall, 495 patients were included in the study and 303 (61.2%) survived the ICU stay. Daily FB in the first 24, 48, and 72 hours after admission and the cumulative FB after 7 days were significantly lower in survivors. Fluid balance exceeding 1000 ml and the use of colloid solutions in the first 72 hours were independently associated with mortality, along with the diagnosis of stroke and shock on admission. CONCLUSIONS A positive FB exceeding 1000 ml in the first 72 hours from admission to the ICU is independently associated with an increased risk of mortality in critically ill patients with cardiovascular disorders. The use of colloid solutions is associated with a higher positive FB.

Prognostication in Very Old Intensive Care Patients with Acute Kidney Injury

“…A substantially negative or positive fluid balance in intensive care patients appears to be correlated with a lack of recovery from AKI that was associated with increased mortality [18,19]. One study by Zhang, et al [19] even showed that an increase by only 1 litre over 72 hours was associated with an increase in mortality. In our study, the fluid balance during days 1-2 and 3-4 was significantly higher in non-survivors compared to survivors.…”

Quality of fluid balance charting and interventions to improve it: a systematic review

“…Open access increased mortality in patients with sepsis, cerebral haemorrhage and heart disease. [6][7][8] Further, dehydration is associated with an increased risk of constipation, urinary tract infections and falls, prolonging hospitalisation and impairing the quality of life. [9][10][11][12] Postoperative fluid balance monitoring is pivotal 13 as both overhydration and dehydration can lead to complications and prolonged hospitalisation following an operation.…”

“…In hospitalised patients, fluid disorders are among the most common problems encountered in clinical practice4 across medical and surgical wards, and fluid balance disorders such as overhydration and dehydration can seriously affect patients’ health. Overhydration is associated with complications such as peripheral oedema and dyspnoea5 and increased mortality in patients with sepsis, cerebral haemorrhage and heart disease 6–8. Further, dehydration is associated with an increased risk of constipation, urinary tract infections and falls, prolonging hospitalisation and impairing the quality of life 9–12.…”

Digitizing fluid balance monitoring may offer a solution for optimizing patient care

“…In a hospital setting, the maintenance of fluid balance is a critical component of patient care, as disturbances in fluid balance can lead to serious medical conditions [ 8 ]. Overhydration and dehydration can have detrimental effects on a patient’s health, including increased morbidity and mortality [ 9 , 10 ], prolonged hospitalization [ 11 , 12 , 13 ], and adverse outcomes such as falls, urinary tract infections, and constipation [ 14 ]. Thus, there is a need for precise and continuous measurement of fluid balance to ensure prompt and appropriate clinical intervention [ 8 , 15 ].…”