Long-term effects of restriction of intravenous fluid in adult ICU patients with septic shock

被引：12

作者：

Kjaer, Maj-Brit Norregaard ^{[1
,2
]}

Meyhoff, Tine Sylvest ^{[1
,2
]}

Sivapalan, Praleene ^{[1
,2
]}

Granholm, Anders ^{[1
,2
]}

Hjortrup, Peter Buhl ^{[1
,3
]}

Madsen, Martin Bruun ^{[1
,3
]}

Moller, Morten Hylander ^{[1
,2
]}

Egerod, Ingrid ^{[1
,2
]}

Wetterslev, Jorn ^{[2
,4
]}

Lange, Theis ^{[2
,5
]}

Cronhjort, Maria ^{[6
]}

Laake, Jon Henrik ^{[7
,8
]}

Jakob, Stephan M. ^{[9
]}

Nalos, Marek ^{[10
]}

Ostermann, Marlies ^{[11
]}

Gould, Doug ^{[12
]}

Cecconi, Maurizio ^{[13
,14
]}

Malbrain, Manu L. N. G. ^{[15
,16
,17
]}

Ahlstedt, Christian ^{[18
]}

Kiel, Louise Bendix ^{[19
]}

Bestle, Morten H. ^{[20
,21
]}

Nebrich, Lars ^{[22
]}

Hildebrandt, Thomas ^{[23
]}

Russell, Lene ^{[24
]}

Vang, Marianne ^{[25
]}

Rasmussen, Michael Lindhart ^{[26
]}

Solling, Christoffer ^{[27
]}

Brochner, Anne Craveiro ^{[2
,28
]}

Krag, Mette ^{[2
,21
,29
]}

Pfortmueller, Carmen ^{[9
]}

Kriz, Miroslav ^{[10
]}

Siegemund, Martin ^{[30
]}

Albano, Giovanni ^{[31
]}

Aagaard, Soren Rosborg ^{[32
]}

Bundgaard, Helle ^{[25
]}

Crone, Vera ^{[29
]}

Wichmann, Sine ^{[20
]}

Johnstad, Bror ^{[33
]}

Martin, Yvonne Karin ^{[34
]}

Seidel, Philipp ^{[35
]}

Martensson, Johan ^{[36
]}

Hollenberg, Jacob ^{[37
]}

Wistrand, Mats ^{[38
,39
]}

Donati, Abele ^{[40
]}

Barbara, Enrico ^{[41
]}

Karvunidis, Thomas ^{[10
]}

Hollinger, Alexa ^{[30
]}

Carsetti, Andrea ^{[40
,42
]}

Lumlertgul, Nuttha ^{[11
,43
]}

Joelsson-Alm, Eva ^{[6
]}

机构：

[1] Copenhagen Univ Hosp, Dept Intens Care, Rigshosp, Blegdamsvej 9, DK-2100 Copenhagen, Denmark

[2] Collaborat Res Intens Care CRIC, Copenhagen, Denmark

[3] Copenhagen Univ Hosp, Dept Cardiothorac Anaesthesia & Intens Care, Rigshosp, Copenhagen, Denmark

[4] Copenhagen Univ Hosp, Ctr Clin Intervent Res, Copenhagen Trial Unit, Rigshosp, Copenhagen, Denmark

[5] Univ Copenhagen, Dept Publ Hlth, Sect Biostat, Copenhagen, Denmark

[6] Karolinska Inst, Dept Clin Sci & Educ, Sect Anaesthes & Intens Care, Sodersjukhuset, Stockholm, Sweden

[7] Oslo Univ Hosp, Dept Anaesthesiol & Intens Care Med, Div Emergencies & Crit Care, Rikshospit, Oslo, Norway

[8] Oslo Univ Hosp, Dept Res & Dev, Div Emergencies & Crit Care, Rikshosp, Oslo, Norway

[9] Univ Bern, Univ Hosp Bern Inselspital, Dept Intens Care Med, Bern, Switzerland

[10] Charles Univ Prague, Teaching Hosp & Biomed Ctr Pilsen, Fac Med, Medical Intens Care Unit,Dept Internal Med 1,Fac, Plzen, Czech Republic

[11] Guys & St ThomasHosp, Dept Intens Care, London, England

[12] Intens Care Natl Audit & Res Ctr ICNARC, Clin Trial Unit, London, England

[13] Humanitas Univ Pieve Emanuele, Dept Biomed Sci, Milan, Italy

[14] Humanitas Res Hosp, Anaesthesia & Intens Care Med IRCCS, Milan, Italy

[15] Univ Hosp Brussels UZB, Dept Intens Care Med, Jette, Belgium

[16] Vrije Univ Brussel VUB, Fac Med & Pharm, Brussels, Belgium

[17] Med Univ Lublin, Dept Anaesthesiol & Intens Therapy 1, Lublin, Poland

[18] Karolinska Univ Hosp Huddinge, Dept Perioperat Med & Intens Care, Stockholm, Sweden

[19] Copenhagen Univ Hosp, Dept Anaesthesia & Intens Care, Bispebjerg, Copenhagen, Denmark

[20] Copenhagen Univ Hosp North Zealand, Dept Anaesthesia & Intens Care, Hillerod, Denmark

[21] Univ Copenhagen, Dept Clin Med, Copenhagen, Denmark

[22] Zealand Univ Hosp, Dept Anaesthesia & Intens Care, Koge, Denmark

[23] Zealand Univ Hosp, Dept Anaesthesia & Intens Care, Roskilde, Denmark

[24] Rigshosp, Copenhagen Acad Med Educ & Simulat, Copenhagen, Denmark

[25] Randers Cent Hosp, Dept Anaesthesia & Intens Care, Randers, Denmark

[26] Herning Hosp, Dept Anaesthesia & Intens Care, Herning, Denmark

[27] Viborg Hosp, Dept Anaesthesia & Intens Care, Viborg, Denmark

[28] Univ Hosp Southern Denmark, Dept Anaesthesia & Intens Care, Odense, Denmark

[29] Holbaek Cent Hosp, Dept Anaesthesia & Intens Care, Holbaek, Denmark

[30] Basel Univ Hosp, Intens Care Unit, Basel, Switzerland

[31] Humanitas Gavazzeni Hosp Bergamo, Dept Anaesthesia & Intens Care, Bergamo, Italy

[32] Aalborg Univ Hosp, Dept Anaesthesia & Intens Care, Aalborg, Denmark

[33] Hosp Innland Hamar, Dept Intens Care, Hamar, Norway

[34] Hosp Ostfold Kalnes, Dept Anesthesia & Intens Care Med, Gralum, Norway

[35] Stavanger Univ Hosp, Dept Intens Care Med, Stavanger, Norway

[36] Karolinska Univ Hosp, Dept Perioperat Med & Intens Care, Solna, Sweden

[37] Karolinska Inst, Ctr Resuscitat Sci, Dept Clin Sci & Educ, Med Intens Care Unit,Sodersjukhuset, Solna, Sweden

[38] Capio St Gorans Hosp, Dept Emergency Med, Stockholm, Sweden

[39] Capio St Gorans Hosp, Dept Anaesthes & Intens Care, Stockholm, Sweden

[40] Univ Politecn Marche, Dept Biomed Sci & Publ Hlth, Ancona, Italy

[41] Humanitas Res Hosp, Anesthesia & Intens Care Unit, Castellanza, Italy

[42] Azienda Osped Univ Marche, Anesthesia & Intens Care Unit, Ancona, Italy

[43] King Chulalongkorn Mem Hosp, Fac Med, Excellence Ctr Crit Care Nephrol, Div Nephrol, Bangkok, Thailand

[44] Oslo Univ Hosp, Dept Res & Dev, Div Emergencies & Crit Care, Oslo, Norway

[45] Univ Oslo, Inst Clin Med, Oslo, Norway

[46] Oslo Univ Hosp Ulleval, Dept Anesthesia & Intens Care, Oslo, Norway

来源：

INTENSIVE CARE MEDICINE | 2023年 / 49卷 / 07期

关键词：

Septic shock; Sepsis; Intravenous fluid; Critical illness; Long-term outcomes; Quality of life; Cognitive function; MONTREAL COGNITIVE ASSESSMENT; SEPSIS; SURVIVORS; VALIDATION; MORTALITY; TOOL;

D O I：

10.1007/s00134-023-07114-8

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

PurposeTo assess long-term outcomes of restrictive versus standard intravenous (IV) fluid therapy in adult intensive care unit (ICU) patients with septic shock included in the European Conservative versus Liberal Approach to Fluid Therapy in Septic Shock in Intensive Care (CLASSIC) trial.MethodsWe conducted the pre-planned analyses of mortality, health-related quality of life (HRQoL) using EuroQol (EQ)-5D-5L index values and EQ visual analogue scale (VAS), and cognitive function using Mini Montreal Cognitive Assessment (Mini MoCA) test at 1 year. Deceased patients were assigned numerical zero for HRQoL as a state equal to death and zero for cognitive function outcomes as worst possible score, and we used multiple imputation for missing data on HRQoL and cognitive function.ResultsAmong 1554 randomized patients, we obtained 1-year data on mortality in 97.9% of patients, HRQoL in 91.3%, and cognitive function in 86.3%. One-year mortality was 385/746 (51.3%) in the restrictive-fluid group versus 383/767 (49.9%) in the standard-fluid group, absolute risk difference 1.5%-points [99% confidence interval (CI) - 4.8 to 7.8]. Mean differences were 0.00 (99% CI - 0.06 to 0.05) for EQ-5D-5L index values, - 0.65 for EQ VAS (- 5.40 to 4.08), and - 0.14 for Mini MoCA (- 1.59 to 1.14) for the restrictive-fluid group versus the standard-fluid group. The results for survivors only were similar in both groups.ConclusionsAmong adult ICU patients with septic shock, restrictive versus standard IV fluid therapy resulted in similar survival, HRQoL, and cognitive function at 1 year, but clinically important differences could not be ruled out.

引用

页码：820 / 830

页数：11

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