EFFECT OF CUMULATIVE FLUID BALANCE DURING ICU STAY ON IN-HOSPITAL MORTALITY IN PATIENTS SURGICALLY TREATED FOR INFECTIVE ENDOCARDITIS

Autor: ANDREJ ŠRIBAR, VLASTA KLARIĆ, VERICA MIKECIN, VLADIMIR KRAJINOVIĆ, IVAN MILAS, JASMINKA PERŠEC
Jazyk: chorvatština
Rok vydání: 2018
Předmět:
Zdroj: Acta medica Croatica : Časopis Akademije medicinskih znanosti Hrvatske
Volume 72
Issue 3
ISSN: 1848-8897
1330-0164
Popis: Infektivni endokarditis (IE) upalna je bolest endokarda uzrokovana mikroorganizmima koji formiraju vegetacije na srčanim zalicima ili septalnim defektima. Dijagnosticira se prema modifi ciranim kriterijima Duke od kojih su najvažniji ehokardiografski vegetacija na površini endokarda i pozitivne hemokulture na najčešće uzročnike IE. Liječi se konzervativno i kirurški. Kod bolesnika kirurški liječenih zbog IE često je prisutna poslijeoperacijska hemodinamska nestabilnost uzrokovana hipovolemijom, slabosti srca multifaktorske etiopatogeneze i poremećajima tonusa periferne vaskulature. Korigira se nadoknadom volumena i korištenjem vazoaktivnih lijekova u perioperacijskom razdoblju. U ovom istraživanju ispitan je utjecaj kumulativne bilance unosa i gubitaka tekućine u jedinici intenzivne medicine (JIM) na unutarbolničku smrtnost, stopu provođenja bubrežnog nadomjesnog liječenja, trajanje mehaničke ventilacije, trajanje boravka u jedinici intenzivne medicine i parametre plućne funkcije u bolesnika operiranih zbog IE. Od 65 ispitanika koji su operirani zbog IE u kliničkoj ustanovi u razdoblju od 4 godine 55 bolesnika je preživjelo, a 10 umrlo (stopa smrtnosti od 15 %). Sedam (70 %) umrlih bolesnika imalo je kumulativnu bilancu tekućine veću od medijana (1190 mL). Binarnom logističkom regresijom, uzevši u obzir kovarijable zbroja SOFA i dobi bolesnika, dokazan je utjecaj kumulativne bilance na povećanje unutarbolničke smrtnosti (exp(B)=2,753, p=0,05). Nije dokazana statistički značajna razlika u kumulativnoj bilanci tekućine između bolesnika kojima je provođeno odnosno nije provođeno bubrežno nadomjesno liječenje, kao ni povezanost kumulativne bilance tekućine i trajanja mehaničke ventilacije, tj. boravka u JIM. Dokazana je statistički značajna povezanost trajanja mehaničke ventilacije i boravka u JIM (Spearman
Introduction: Infective endocarditis (IE) is an infl ammatory disease of endocardium caused by bacteria or fungi. It is caused microbial adhesion to endocardial surface caused by the presence of bacteria or fungi in the bloodstream. Its clinical features are fever, malaise, heart murmurs, shortness of breath and symptoms caused by septic emboli. Current standard in the diagnosis of IE are Duke criteria, according to which two major (echocardiographic evidence and positive blood cultures for most common infective agents that cause IE), one major and three minor or fi ve minor (pre-existing cardiac conditions, fever, vascular phenomena, immunologic phenomena and positive blood cultures) criteria need to be present to confi rm the diagnosis of IE. It is treated with targeted antimicrobial therapy, and open-heart surgery using cardiopulmonary bypass is performed if there is persistent bacteremia, signifi cant hemodynamic instability or threat of septic embolization. Hemodynamic instability is common during postoperative period due to systemic infl ammatory response and myocardial injury after cardiopulmonary bypass and it is treated with volume replacement and vasoactive drugs. Aim: The aim of this study was to determine whether increased fl uid balance during intensive care unit (ICU) stay after IE surgery had an effect on in-hospital mortality, duration of mechanical ventilation and ICU stay, need for renal replacement therapy and postoperative lung function. Sixty-fi ve patients operated for native valve IE and treated in ICU specialized for cardiac patients in a tertiary hospital were included in this observational study. Design of the study was approved by the institutional ethics committee. Patients with pre-existing lung disease, history of malignant disease in the last 5 years, or history of organ transplantation were excluded. Demographic data (age and gender), clinical variables needed to calculate SOFA (sepsis related organ failure assessment) score, ventilator settings, fl uid gains and losses during ICU stay, duration of mechanical ventilation and ICU stay, PaO2/FiO2 ratio at ICU admission and at 3, 6, 12 and 24 h post-admission, and in-hospital mortality data were collected. There were 55 (85%) male and ten (15%) female patients, mean age 54.2±15 years. Median fl uid gain/loss balance was +1190 mL (IQR -120 mL - +3090 mL), median duration of mechanical ventilation was 17 h (IQR 13.5-22.5 h) and median duration of ICU stay was 60 h (IQR 42-82 h). Ten (15%) patients died during hospital stay. Non-survivors had a signifi cantly higher proportion of fl uid balance above median (70% vs. 30%) compared to survivors (56% vs. 44%) (p=0.05, age and SOFA score adjusted binomial logistic regression with post-hoc Bonferroni correction). Correlation was found between duration of mechanical ventilation and ICU stay (Spearman’s
Databáze: OpenAIRE
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