title: Impact of positive fluid balance on critically ill surgical patients: a prospective observational study.
abstract: OBJECTIVE
  The purpose of this study is to determine the effect of postoperative fluid balance (FB) on subsequent outcomes in acute care surgery (ACS) patients admitted to the surgical intensive care unit (ICU).
  
  
  METHODS
  Acute care surgery patients admitted to the surgical ICU from 06/2012 to 01/2013 were followed up prospectively. Patients were stratified by FB into FB-positive (+) and FB-negative (-) groups by surgical ICU day 5 or day of discharge from the surgical ICU.
  
  
  RESULTS
  A total of 144 ACS patients met inclusion criteria. Although there was no statistically significant difference in crude mortality (11% for FB [-] vs 15.5% for FB [+]; P=.422], after adjusting for confounding factors, achieving an FB (-) status by day 5 during the surgical ICU stay was associated with an almost 70% survival benefit (adjusted odds ratio [95% confidence interval], 0.31 [0.13, 0.76]; P=.010). In addition, achieving a fluid negative status by day 1 provided a protective effect for both overall and infectious complications (adjusted odds ratio [95% confidence interval], 0.63 [0.45, 0.88]; P=.006 and 0.64 [0.46, 0.90]; P=.010, respectively).
  
  
  CONCLUSIONS
  In a cohort of critically ill ACS patients, achieving FB (-) status early during surgical ICU admission was associated with a nearly 70% reduction in the risk for mortality.
authors.affiliation: Department of Surgery, Division of Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.affiliation: Department of Surgery, Division of Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Liou
authors.affiliation: Department of Surgery, Division of Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Debora
authors.initials: D
authors.lastname: Lee
authors.affiliation: Department of Surgery, Division of Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Fierro
authors.affiliation: Department of Surgery, Division of Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bloom
authors.affiliation: Department of Surgery, Division of Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Eric
authors.initials: E
authors.lastname: Ley
authors.affiliation: Department of Surgery, Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA.
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.affiliation: Department of Trauma and Critical Care, Delray Medical Center, Delray Beach, FL; Broward General Medical Center, Fort Lauderdale, FL. Electronic address: mbukur@browardhealth.org.
authors.forename: Marko
authors.initials: M
authors.lastname: Bukur
mesh_terms: D018806:APACHE; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000401:mortality*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000401:mortality*; D013997:Time Factors; D014882:Water-Electrolyte Balance / Q000502:physiology*
keywords: Fluid balance; Fluid overload; Infections; Mortality; Negative fluid balance