A Prospective Observational Study of Rational Fluid Therapy in Asian Intensive Care Units: Another Puzzle Piece in Fluid Therapy

Jacob, Matthias; Sahu, Sambit; Singh, Yogendra P.; Mehta, Yatin; Yang, Kuang-Yao; Kuo, Shuenn-Wen; Memom, Farooq; Prayag, Shirish; Pande, Rajesh; Jaiswal, Nirmal; Cheng, Tan C.; Mandal, Amit; Deva, Shanti R.; Mathew, Mohan; Ramakrishnan, Nagarajan; Rai, Vineya; Wah, Luah; Ramachandran, Gopinath; Chawla, Rajesh; Khan, Z. A.; Divatia, J. V.; Mishra, Rajesh; Amin, Pravin; Shelgaokar, Jayant; Zwissler, Bernhard; Aken, Hugo Van und Ertmer, Christian (2020): A Prospective Observational Study of Rational Fluid Therapy in Asian Intensive Care Units: Another Puzzle Piece in Fluid Therapy. In: Indian Journal of Critical Care Medicine, Bd. 24, Nr. 11: S. 1028-1036

Abstract

Introduction: Fluid therapy in critically ill patients, especially timing and fluid choice, is controversial. Previous randomized trials produced conflicting results. This observational study evaluated the effect of colloid use on 90-day mortality and acute kidney injury (RIFLE F) within the Rational Fluid Therapy in Asia (RaFTA) registry in intensive care units. Materials and methods: RaFTA is a prospective, observational study in Asian intensive care unit (ICU) patients focusing on fluid therapy and related outcomes. Logistic regression was performed to identify risk factors for increased 90-day mortality and acute kidney injury (AKI). Results:Twenty-four study centers joined the RaFTA registry and collected 3,187 patient data sets from November 2011 to September 2012. A follow-up was done 90 days after ICU admission. For 90-day mortality, significant risk factors in the overall population were sepsis at admission (OR 2.185 [1.799;2.654], p < 0.001), cumulative fluid balance (OR 1.032 [1.018;1.047], p < 0.001), and the use of vasopressors (OR 3.409 [2.694;4.312], p < 0.001). The use of colloids was associated with a reduced risk of 90-day mortality (OR 0.655 [0.478;0.900], p = 0.009). The initial colloid dose was not associated with an increased risk for AKI (OR 1.094 [0.754;1.588], p = 0.635). Conclusion: RaFTA adds the important finding that colloid use was not associated with increased 90-day mortality or AKI after adjustment for baseline patient condition. Clinical significance: Early resuscitation with colloids showed potential mortality benefit in the present analysis. Elucidating these findings may be an approach for future research.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0972-5229
• Sprache: Englisch