Impact of late fluid balance on clinical outcomes in the critically ill surgical and trauma population.
OBJECTIVE
Management of fluid status in critically ill patients poses a significant challenge due to limited literature. This study aimed to determine the impact of late fluid balance management after initial adequate fluid resuscitation on in-hospital mortality for critically ill surgical and trauma patients.


METHODS
This single-center retrospective cohort study included 197 patients who underwent surgical procedure within 24 hours of surgical intensive care unit admission. Patients with high fluid balance on postoperative day 7 (>5 L) were compared with those with a low fluid balance (≤5 L) with a primary end point of in-hospital mortality. Subgroup analyses were performed based on diuretic administration, diuretic response, and type of surgery.


RESULTS
High fluid balance was associated with significantly higher in-hospital mortality (30.2 vs 3%, P<.001) compared with low fluid balance; this relationship remained after multivariable regression analysis. High fluid balance was associated with increased mortality, independent of diuretic administration, diuretic response, and type of surgery.


CONCLUSIONS
Consistent with previous literature, high fluid balance on postoperative day 7 was associated with increased in-hospital mortality. Patients who received and responded to diuretic therapy did not demonstrate improved clinical outcomes, which questions their use in the postoperative period.
The Ohio State University Wexner Medical Center, Columbus, OH.
Kathryn A
KA
Elofson
The Ohio State University Wexner Medical Center, Columbus, OH.
Daniel S
DS
Eiferman
The Ohio State University Wexner Medical Center, Columbus, OH.
Kyle
K
Porter
The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: Claire.Murphy@osumc.edu.
Claire V
CV
Murphy
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004232:Diuretics / Q000008:administration & dosage; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012044:Regression Analysis; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000706:statistics & numerical data; D014882:Water-Electrolyte Balance / Q000502:physiology*; D014947:Wounds and Injuries / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D055815:Young Adult
D004232:Diuretics
Critical illness; Diuretics; Fluid balance; Fluid therapy; General surgery; Postoperative period