Hypervolemia as one of the predictors of poor outcome in the patients at the resuscitation and intensive care unit


Yu.Р. Orlov1,2, N.V. Govorova1, A.V. Glushchenko1,2, M.S. Nejfeld1, I.A. Gorst1

1 Federal State Budgetary Educational Institution of Further Professional Education Omsk State Medical University of the Ministry of Healthcare of Russian Federation, Omsk

2 GBU City clinical emergency hospital No. 1, Omsk

For correspondence: Orlov Yuriy Petrovich — Dr. Med. Sci., Professor of Anesthesiology and reanimatology FGBOU in Omsk State Medical University of the Ministry of health, Omsk; e-mail: orlovup@mail.ru

For citation: Orlov Yu.Р., Govorova N.V., Glushchenko A.V., Nejfeld M.S., Gorst I.A. Hypervolemia as one of the predictors of poor outcome in the patients at the resuscitation and intensive care unit. Alexander Saltanov Intensive Care Herald. 2018;4:51–56.

DOI: 10.21320/1818-474X-2018-4-51-56

Objective: to assess three-day positive water balance when conducting fluid therapy and to evaluate its impact on the survival of patients hospitalized in the ICU with a diagnosis of polytrauma.

Methods. In a retrospective study included data 2 groups: I group — transferred to other offices with improved status (n = 20), group II — ICU deaths (n = 20) in the period up to 30 days. The average period of patient in the ICU in II group amounted to 14.5 ± 7.1 days. The average age of the patients was 49.8 ± 0.6 years, 27 patients were age under 60 years old, 13-over 60 years. Patients included in the sample, there were only diagnosed with multiple trauma, hypovolemic shock, with no effect on volemic load and the need to use vazopressors. When aggregating establish probability p < 0.05, studentʼs applied t-test, Wald–Wolfowitz criteria, Mann–Whitney and Kolmogorov–Smirnov, ROC curve analysis and analysed the odds ratio and relative risk of death for each group of patients.

The results. Found that the average value of a positive water balance for three days was statistically significantly higher in the deceased patients (5427.2 ± 1040.3 ml) than in survivors (3345 ± 1268 ml). In patients with a large amount of the positive balance of water for 3 days mortality risk is observed in 5.1 times greater (95% CI [0.773–0.992] in p < 0.005) than among patients, a positive water balance, which in total for 3 nights was less 4075 ml.

Conclusion. In patients with a large amount of positive water balance (more 4075 ml) for 3 days of stay in ICU mortality risk is observed in 5.1 times more common than among patients whose water balance for 3 days was less 4075 ml. Using the three-day figure is a positive water balance can be accurate to 96.7 % define an adverse outcome severely traumatized patients (< 0.05, 95% CI [0.773–0.992]).

Keywords: hypervolemia, infusion therapy, polytrauma

Received: 22.10.2018

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