Asociación de los grados de quemosis con el balance de líquidos en pacientes críticos

Abstract

Objectives

In the intensive care unit (ICU) patients are exposed to ocular complications such as chemosis, which may be linked to fluid overload. The study evaluated the potential utility of chemosis as an objective sign for the early detection of this condition, analyzing its relationship with cumulative fluid balance and its connection to the Godet sign.

Design

A prospective cohort study conducted over one year in the ICU of two hospital centers included 251 patients over 18 years with fluid overload.

Results

76.8% of patients developed grade 3 chemosis, detected on average on day 3.5 (± 0.4). Patients with grade 2 chemosis had a 2.3-fold increased risk of exceeding a fluid balance of 8000 ml (95% CI: 1.07-5.12, P = .032), while those with grade 3 chemosis had a 3.7-fold increased risk (95% CI: 1.7-8.09, P = .009). Patients with Godet +++ and ++++ had 2.5 (95% CI: 4.67-5.78, P = .016) and 4.4 (95% CI: 3.23-7.09, P = .020) times higher probabilities of developing grade 2 and grade 3 chemosis, respectively. In the adjusted analysis, a fluid balance greater than 8001 mL was associated with a 5.6-fold higher probability of developing chemosis (95% CI: 1.98-4.21, P = .010).

Conclusions

A strong correlation was found between chemosis, fluid overload, and the Godet sign, suggesting that chemosis could be a relevant clinical marker of tissue congestion in critically ill patients, even before being detected by ultrasonography.