The effect of positive balance on the outcomes of critically ill noncardiac postsurgical patients

A retrospective cohort study

Hong Jin Shim, Ji Young Jang, Seung Hwan Lee, JaeGil Lee

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose: Fluid balance remains a highly controversial topic in the critical care field, and no consensus has been reached about the fluid levels required by critically ill surgical patients. In this study, we investigated the relationship between fluid balance and in-hospital mortality in critically ill surgical patients. Methods: The medical records of adult patients managed in a surgical intensive care unit (ICU) for more than 48 hours after surgery from January 2010 to February 2011 were reviewed retrospectively. Abstracted data included body weights, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, Sequential Organ Failure Assessment (SOFA) scores, fluid therapy values (intake, output, and balance) during the ICU stay, type of operation, length of stay in the ICU and hospital, and in-hospital mortality. Results: A total of 148 patients were enrolled. The in-hospital mortality rate was 20.8%, and the median length of stay in the ICU and hospital were 5.0 and 24 days, respectively. The median daily fluid balance over the first 3 postoperative days was positive 11.2 mL/kg. Fluid balances in the ICU were 19.2, 15.0, and -0.6 mL kg-1 d-1, respectively, during the first 3 days vs SOFA scores (6.8, 6.3, and 6.5). Comparing the nonsurvival group with the survival group, the univariate analysis showed that age (P = .05), APACHE II score (P < .001), and use of a vasopressor (norepinephrine) (P = .05) affect in-hospital mortality. In the overall patients, any of the fluid balances were not significantly associated with mortality. However, in critically ill patients whose APACHE II scores were greater than 20, the nonsurvivor group showed a significant tendency toward a positive balance compared with the survivor group on the second and third days of ICU stay. Nevertheless, the SOFA scores showed no difference between nonsurvivor and survivors during the initial 2 postoperative days. Conclusion: In critically ill noncardiac postsurgical patients whose APAHCE II scores were greater than 20, a positive balance in the ICU can be associated with mortality risk. To determine the direct effect of positive fluid balance, a larger scaled, prospective randomized study will be required.

Original languageEnglish
Pages (from-to)43-48
Number of pages6
JournalJournal of Critical Care
Volume29
Issue number1
DOIs
Publication statusPublished - 2014 Feb 1

Fingerprint

Water-Electrolyte Balance
Critical Illness
Intensive Care Units
Cohort Studies
Retrospective Studies
Organ Dysfunction Scores
Hospital Mortality
APACHE
Critical Care
Survivors
Mortality
Length of Stay
Fluid Therapy
Medical Records
Norepinephrine
Body Weight
Prospective Studies
Survival

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

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title = "The effect of positive balance on the outcomes of critically ill noncardiac postsurgical patients: A retrospective cohort study",
abstract = "Purpose: Fluid balance remains a highly controversial topic in the critical care field, and no consensus has been reached about the fluid levels required by critically ill surgical patients. In this study, we investigated the relationship between fluid balance and in-hospital mortality in critically ill surgical patients. Methods: The medical records of adult patients managed in a surgical intensive care unit (ICU) for more than 48 hours after surgery from January 2010 to February 2011 were reviewed retrospectively. Abstracted data included body weights, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, Sequential Organ Failure Assessment (SOFA) scores, fluid therapy values (intake, output, and balance) during the ICU stay, type of operation, length of stay in the ICU and hospital, and in-hospital mortality. Results: A total of 148 patients were enrolled. The in-hospital mortality rate was 20.8{\%}, and the median length of stay in the ICU and hospital were 5.0 and 24 days, respectively. The median daily fluid balance over the first 3 postoperative days was positive 11.2 mL/kg. Fluid balances in the ICU were 19.2, 15.0, and -0.6 mL kg-1 d-1, respectively, during the first 3 days vs SOFA scores (6.8, 6.3, and 6.5). Comparing the nonsurvival group with the survival group, the univariate analysis showed that age (P = .05), APACHE II score (P < .001), and use of a vasopressor (norepinephrine) (P = .05) affect in-hospital mortality. In the overall patients, any of the fluid balances were not significantly associated with mortality. However, in critically ill patients whose APACHE II scores were greater than 20, the nonsurvivor group showed a significant tendency toward a positive balance compared with the survivor group on the second and third days of ICU stay. Nevertheless, the SOFA scores showed no difference between nonsurvivor and survivors during the initial 2 postoperative days. Conclusion: In critically ill noncardiac postsurgical patients whose APAHCE II scores were greater than 20, a positive balance in the ICU can be associated with mortality risk. To determine the direct effect of positive fluid balance, a larger scaled, prospective randomized study will be required.",
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The effect of positive balance on the outcomes of critically ill noncardiac postsurgical patients : A retrospective cohort study. / Shim, Hong Jin; Jang, Ji Young; Lee, Seung Hwan; Lee, JaeGil.

In: Journal of Critical Care, Vol. 29, No. 1, 01.02.2014, p. 43-48.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The effect of positive balance on the outcomes of critically ill noncardiac postsurgical patients

T2 - A retrospective cohort study

AU - Shim, Hong Jin

AU - Jang, Ji Young

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AU - Lee, JaeGil

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N2 - Purpose: Fluid balance remains a highly controversial topic in the critical care field, and no consensus has been reached about the fluid levels required by critically ill surgical patients. In this study, we investigated the relationship between fluid balance and in-hospital mortality in critically ill surgical patients. Methods: The medical records of adult patients managed in a surgical intensive care unit (ICU) for more than 48 hours after surgery from January 2010 to February 2011 were reviewed retrospectively. Abstracted data included body weights, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, Sequential Organ Failure Assessment (SOFA) scores, fluid therapy values (intake, output, and balance) during the ICU stay, type of operation, length of stay in the ICU and hospital, and in-hospital mortality. Results: A total of 148 patients were enrolled. The in-hospital mortality rate was 20.8%, and the median length of stay in the ICU and hospital were 5.0 and 24 days, respectively. The median daily fluid balance over the first 3 postoperative days was positive 11.2 mL/kg. Fluid balances in the ICU were 19.2, 15.0, and -0.6 mL kg-1 d-1, respectively, during the first 3 days vs SOFA scores (6.8, 6.3, and 6.5). Comparing the nonsurvival group with the survival group, the univariate analysis showed that age (P = .05), APACHE II score (P < .001), and use of a vasopressor (norepinephrine) (P = .05) affect in-hospital mortality. In the overall patients, any of the fluid balances were not significantly associated with mortality. However, in critically ill patients whose APACHE II scores were greater than 20, the nonsurvivor group showed a significant tendency toward a positive balance compared with the survivor group on the second and third days of ICU stay. Nevertheless, the SOFA scores showed no difference between nonsurvivor and survivors during the initial 2 postoperative days. Conclusion: In critically ill noncardiac postsurgical patients whose APAHCE II scores were greater than 20, a positive balance in the ICU can be associated with mortality risk. To determine the direct effect of positive fluid balance, a larger scaled, prospective randomized study will be required.

AB - Purpose: Fluid balance remains a highly controversial topic in the critical care field, and no consensus has been reached about the fluid levels required by critically ill surgical patients. In this study, we investigated the relationship between fluid balance and in-hospital mortality in critically ill surgical patients. Methods: The medical records of adult patients managed in a surgical intensive care unit (ICU) for more than 48 hours after surgery from January 2010 to February 2011 were reviewed retrospectively. Abstracted data included body weights, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, Sequential Organ Failure Assessment (SOFA) scores, fluid therapy values (intake, output, and balance) during the ICU stay, type of operation, length of stay in the ICU and hospital, and in-hospital mortality. Results: A total of 148 patients were enrolled. The in-hospital mortality rate was 20.8%, and the median length of stay in the ICU and hospital were 5.0 and 24 days, respectively. The median daily fluid balance over the first 3 postoperative days was positive 11.2 mL/kg. Fluid balances in the ICU were 19.2, 15.0, and -0.6 mL kg-1 d-1, respectively, during the first 3 days vs SOFA scores (6.8, 6.3, and 6.5). Comparing the nonsurvival group with the survival group, the univariate analysis showed that age (P = .05), APACHE II score (P < .001), and use of a vasopressor (norepinephrine) (P = .05) affect in-hospital mortality. In the overall patients, any of the fluid balances were not significantly associated with mortality. However, in critically ill patients whose APACHE II scores were greater than 20, the nonsurvivor group showed a significant tendency toward a positive balance compared with the survivor group on the second and third days of ICU stay. Nevertheless, the SOFA scores showed no difference between nonsurvivor and survivors during the initial 2 postoperative days. Conclusion: In critically ill noncardiac postsurgical patients whose APAHCE II scores were greater than 20, a positive balance in the ICU can be associated with mortality risk. To determine the direct effect of positive fluid balance, a larger scaled, prospective randomized study will be required.

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