Hemodynamic effects of slower versus faster intravenous fluid bolus rates in critically ill patients: An observational study

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2024-12-18 DOI:10.1016/j.jcrc.2024.154985

Daniere Yurie Vieira Tomotani , Flávio Geraldo Rezende Freitas , Alexandre Biasi Cavalcante , Ary Serpa Neto , Rodrigo Cruvinel Figueiredo , Rodrigo Santos Biondi , João Manoel Silva-Jr , Bruno Adler Maccagnan Pinheiro Besen , Jorge Luiz da Rocha Paranhos , Fernando José da Silva Ramos , Fernanda Chohfi Atallah , Thiago Miranda Lopes de Almeida , Maria Aparecida de Souza , Fernando Godinho Zampieri , Flávia Ribeiro Machado , BRICNet

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引用次数: 0

Abstract

Purpose

We compared the immediate and sustained effects of 500 mL of crystalloid administered at slow (333 mL/h) versus fast rates (999 mL/h) on mean arterial pressure (MAP) in critically ill patients.

Materials and methods

Hemodynamic variables were collected immediately before and every 30 min up to 60 min after the end of the infusion. The primary outcome was the adjusted difference in MAP.

Results

We included 146 patients (slow rate: 71, fast rate: 75). One hour after the end of the infusion, there was no difference in the overall mean marginal effect on MAP between the groups [1.9 mmHg (95 % CI: −1.5 to 5.3 mmHg), p = 0.27] or on the perfusion parameters. Similarly, no difference was found in the immediate effect after 90 min [overall marginal effect: 1.1 mmHg (95 % CI: −2.3 to 4.6 mmHg); p = 0.52]. In patients with cardiac output (CO) monitoring, there was an increase in CO in the fast rate group (overall mean marginal effect: 1.78 L/min (95 % CI: 0.08 to 3.48 L/min); p = 0.04).

Conclusion

In critically ill patients, crystalloid infusion at both fast and slow rates did not lead to immediate or sustained differences in MAP. However, fast infusion may result in a greater increase in CO.

查看原文本刊更多论文

在危重病人中较慢和较快静脉输液速度的血流动力学影响：一项观察性研究。

目的：我们比较了500 mL晶体以慢速（333 mL/h）和快速（999 mL/h）给药对危重患者平均动脉压（MAP）的即时和持续影响。材料与方法：在注射前及注射结束后每隔30分钟至60分钟采集血液动力学参数。主要终点是MAP调整后的差异。结果：纳入146例患者（慢速71例，快速75例）。注射结束1小时后，两组间MAP的总体平均边际效应[1.9 mmHg (95% CI: -1.5 ~ 5.3 mmHg), p = 0.27]或灌注参数均无差异。同样，90分钟后的即时效果也没有差异[总体边际效应：1.1 mmHg (95% CI: -2.3至4.6 mmHg)；p = 0.52]。在进行心输出量（CO）监测的患者中，快速组的CO增加(总体平均边际效应：1.78 L/min (95% CI: 0.08 ~ 3.48 L/min)；p = 0.04)。结论：在危重患者中，快速和慢速晶体输注均不会导致MAP立即或持续的差异。然而，快速输注可能导致CO的更大增加。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.