ICU患者在去复苏阶段利尿剂反应性的意义:一项回顾性观察研究。

IF 2.9 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Amir Gal Oz, Noam Goder, Yael Lichter, Or Goren, Reut Schvartz, Yacov Shacham, Shiran Gabay, Nimrod Adi, Ron Wald, Dekel Stavi
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引用次数: 0

摘要

背景:液体管理是危重病人护理的一个关键方面。虽然液体超载与不良后果有关,但实现负液体平衡和保持肾功能之间的平衡是一项临床挑战,而且在去复苏阶段患者中利尿剂反应性的意义尚不清楚。目的:本研究旨在评估ICU患者在复苏阶段的强迫利尿、体液平衡和临床结果之间的关系。此外,我们评估了肾功能的改变是否会影响患者的预后。方法:采用回顾性队列研究,纳入527例危重患者,在ICU住院期间使用呋塞米治疗3天以上。分析了体液平衡、肾功能变化(通过KDIGO标准评估)和临床结果,包括ICU死亡率和修改后的SOFA评分(不包括肾功能)。结果:同时实现体液负平衡和肾功能改善的患者死亡率最低,预后更好。相反,那些尽管被迫利尿但体液平衡仍为阳性且肾功能恶化的患者死亡率和器官功能障碍进展最高。血管加压剂的使用和机械通气与较差的预后相关。结论:在去指标期强制利尿的ICU患者中,无反应者是高危人群。这些发现强调了个体化液体管理策略的必要性,并强调了进一步前瞻性研究的重要性,以阐明强制利尿在危重患者中的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Significance of Diuretic Responsiveness in ICU Patients during the De- Resuscitation Phase: A Retrospective Observational Study.

Background: Fluid management is a critical aspect of care in critically ill patients. While fluid overload has been linked to adverse outcomes, the balance between achieving a negative fluid balance and preserving kidney function presents a clinical challenge, and the significance of diuretic responsiveness in patients in the de-resuscitation phase remains unclear.

Objective: This study aimed to evaluate the association between forced diuresis, fluid balance, and clinical outcomes in ICU patients during the de- resuscitation phase. Additionally, we assessed whether changes in kidney function influence prognosis in this patient population.

Methods: A retrospective cohort study was conducted, including 527 critically ill patients treated with furosemide for at least three days during their ICU stay. Fluid balance, kidney function changes (assessed via KDIGO criteria), and clinical outcomes, including ICU mortality and modified SOFA score (excluding renal function), were analyzed.

Results: Patients who achieved both a negative fluid balance and improvement in kidney function had the lowest mortality rates and better outcomes. Conversely, those who remained in positive fluid balance despite forced diuresis and exhibited worsening kidney function had the highest mortality and organ dysfunction progression. The presence of vasopressor use and mechanical ventilation was associated with poorer outcomes.

Conclusion: Among ICU patients undergoing forced diuresis during the de- indicator, non-responsiveness signals a high-risk population. These findings underscore the need for individualized fluid management strategies and highlight the importance of further prospective studies to clarify the role of forced diuresis in critically ill patients.

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来源期刊
Cardiorenal Medicine
Cardiorenal Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-UROLOGY & NEPHROLOGY
CiteScore
5.40
自引率
2.60%
发文量
25
审稿时长
>12 weeks
期刊介绍: The journal ''Cardiorenal Medicine'' explores the mechanisms by which obesity and other metabolic abnormalities promote the pathogenesis and progression of heart and kidney disease (cardiorenal metabolic syndrome). It provides an interdisciplinary platform for the advancement of research and clinical practice, focussing on translational issues.
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