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Early negative fluid balance is associated with lower mortality after cardiovascular surgery

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机构: [1]Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China [2]Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China [3]Intensive Care Unit, Fuxing Hospital, Capital Medical University, Beijing, China
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关键词: cardiac surgical procedures postoperative management fluid balance outcome mortality

摘要:
Background: Early fluid expansion could prevent postoperative organ hypoperfusion. However, excessive fluid resuscitation adversely influences multiple organ systems. This retrospective, observational study aimed to investigate the relationship between early negative fluid balance and postoperative mortality in critically ill adult patients following cardiovascular surgery. Methods: In total, 567 critically ill patients who had undergone cardiovascular surgery and whose intensive care unit length of stay (LOS) was more than 24 hours were enrolled. The baseline characteristics, daily fluid balance and cumulative fluid balance were obtained. Patients were followed until discharge or day 28. Multivariate logistic regressions adjusted by propensity score were used to analyze the relationship between early negative fluid balance and postoperative mortality. Results: Overall, postoperative mortality was 6.2% (35/567). Acute Physiology and Chronic Health Evaluation II on admission (odd ratios [OR] 1.110), acute kidney injury stage (OR 1.639) and renal replacement therapy received (OR 3.922) were the independent risk factors of postoperative mortality, whereas negative daily fluid balance at day 2 (OR 0.411) was the protective factor. Patients with a negative daily fluid balance at day 2 had lower postoperative mortality (3.4% vs. 12.2% in the positive fluid balance group), lower acute kidney injury (AKI) stage, were less likely to receive renal replacement therapy (RRT) and experienced shorter hospital LOS compared with those with a daily positive fluid balance. Conclusion: This retrospective, observational study indicates that early negative fluid balance is associated with lower postoperative mortality in critically ill patients following cardiovascular surgery. Further prospective, randomized trials are needed to prove the benefits from the restrictive fluid management strategy.

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出版当年[2017]版:
大类 | 4 区 医学
小类 | 4 区 心脏和心血管系统 4 区 外周血管病
最新[2023]版:
大类 | 4 区 医学
小类 | 4 区 心脏和心血管系统 4 区 外周血管病
JCR分区:
出版当年[2016]版:
Q4 PERIPHERAL VASCULAR DISEASE Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
最新[2023]版:
Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Q4 PERIPHERAL VASCULAR DISEASE

影响因子: 最新[2023版] 最新五年平均 出版当年[2016版] 出版当年五年平均 出版前一年[2015版] 出版后一年[2017版]

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第一作者机构: [1]Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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通讯机构: [1]Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China [*1]Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Rd, Chaoyang District, Beijing, 100029, P.R. China.
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