The effect of excess fluid balance on the mortality rate of surgical patients: a multicenter prospective study

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art_SILVA JR._The_effect_of_excess_fluid_balance_on_the_2013.PDF (215.36 KB)
Citações na Scopus
114
Tipo de produção
article
Data de publicação
2013
DOI
Scopus
Web of Science
Título da Revista
ISSN da Revista
Título do Volume
Editora
BIOMED CENTRAL LTD
Autores
NOGUEIRA, Fernando Augusto Mendes
VIANNA, Pedro Monferrari Monteiro
PEREIRA FILHO, Marcos Cruz
DIAS, Leandro Ferreira
MAIA, Vivian Paz Leao
NEUCAMP, Cesar de Souza
AMENDOLA, Cristina Prata
Citação
CRITICAL CARE, v.17, n.6, article ID R288, 7p, 2013
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Introduction: In some studies including small populations of patients undergoing specific surgery, an intraoperative liberal infusion of fluids was associated with increasing morbidity when compared to restrictive strategies. Therefore, to evaluate the role of excessive fluid infusion in a general population with high-risk surgery is very important. The aim of this study was to evaluate the impact of intraoperative fluid balance on the postoperative organ dysfunction, infection and mortality rate. Methods: We conducted a prospective cohort study during one year in four ICUs from three tertiary hospitals, which included patients aged 18 years or more who required postoperative ICU after undergoing major surgery. Patients who underwent palliative surgery and whose fluid balance could change in outcome were excluded. The calculation of fluid balance was based on preoperative fasting, insensible losses from surgeries and urine output minus fluid replacement intraoperatively. Results: The study included 479 patients. Mean age was 61.2 +/- 17.0 years and 8.8% of patients died at the hospital during the study. The median duration of surgery was 4.0 (3.2 to 5.5) h and the value of the Simplified Acute Physiology Score (SAPS) 3 score was 41.8 +/- 14.5. Comparing survivors and non-survivors, the intraoperative fluid balance from non-survivors was higher (1,950 (1,400 to 3,400) mL vs. 1,400 (1,000 to 1,600) mL, P < 0.001). Patients with fluid balance above 2,000 mL intraoperatively had a longer ICU stay (4.0 (3.0 to 8.0) vs. 3.0 (2.0 to 6.0), P < 0.001) and higher incidence of infectious (41.9% vs. 25.9%, P = 0.001), neurological (46.2% vs. 13.2%, P < 0.001), cardiovascular (63.2% vs. 39.6%, P < 0.001) and respiratory complications (34.3% vs. 11.6%, P < 0.001). In multivariate analysis, the fluid balance was an independent factor for death (OR per 100 mL = 1.024; P = 0.006; 95% CI 1.007 to 1.041). Conclusions: Patients with excessive intraoperative fluid balance have more ICU complications and higher hospital mortality.
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URI
https://observatorio.fm.usp.br/handle/OPI/5047
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MCG
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/08