Balanço hídrico e desfechos adversos em pacientes com Covid-19 em unidade de terapia intensiva

Detalhes bibliográficos
Autor(a) principal: Rocha, Greiciane Gonçalves Carati da
Data de Publicação: 2021
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Biblioteca Digital de Teses e Dissertações da PUC_RS
Texto Completo: http://tede2.pucrs.br/tede2/handle/tede/9966
Resumo: Volume control in intensive care unit (ICU) is essential for the management of patients, and fluid balance has been suggested a valuable biomarker of critical illness. A positive association between positive fluid balance and mortality has been reported, but the impact of fluid balance and fluid overload has not been evaluated in patients with coronavirus disease 2019 (COVID-19). The aim of the present study was to evaluate the importance of fluid balance in COVID-19 patients admitted to ICU and its association with Kidney replacement therapy and mortality. Observational study including individuals admitted to ICU patients with an ICU stay longer than 24 hours. Exclusion criteria were age under 18 years, chronic dialysis and individuals with cerebral death. Files were revised for patient clinical characteristics, fluid administration and balance, physiological and laboratory data, diagnoses, and given treatment using case report forms. Data on fluid balance were recorded from admission to day 7. Increased in fluids of at least 5 and 10% were considered as fluid overload. Special attention was given to death, need of invasive mechanical ventilation, vasopressor drugs and dialysis A total of 176 intensive care patients with COVID-19 were included. Mean age was 58.7 (SD 15.4) years, and male to female ratio was almost 1. Most patient died (N 97, 55.1%), Kidney replacement therapy was performed in 32 (18.2%), invasive mechanical ventilation in 159 (90.3 %) and vasopressor was used in 140 (79.5%) patients. Mortality was increased in patients with a higher positive fluid balance. Median daily fluid balance was higher in non survivors than survivors, in dialysis than non-dialysis patients and in patients receiving invasive mechanical ventilation. Fluid overload defined with a threshold of 10% and 5% were used to design survival curves for mortality and for starting dialysis. Death and the probability of receiving dialysis were increases with fluid overload above 10 and 5%. In conclusion the present study shows that positive fluid balance in intensive care patients with COVID-19 is associated with mortality and need of Kidney replacement therapy and invasive mechanical ventilation. We are not aware of other studies disclosing such association in patients with SARS-CoV-2 infection in ICU. Further work is needed to evaluate if preventive measures to reduce fluid balance, restrictive fluid resuscitation, use of diuretics, or early kidney replacement therapy to treat fluid overload are effective in reducing mortality and morbidity.
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spelling Figueiredo , Carlos Eduardo Poli dehttp://lattes.cnpq.br/7183837354797239http://lattes.cnpq.br/0239870145053601Rocha, Greiciane Gonçalves Carati da2021-11-11T18:08:13Z2021-08-31http://tede2.pucrs.br/tede2/handle/tede/9966Volume control in intensive care unit (ICU) is essential for the management of patients, and fluid balance has been suggested a valuable biomarker of critical illness. A positive association between positive fluid balance and mortality has been reported, but the impact of fluid balance and fluid overload has not been evaluated in patients with coronavirus disease 2019 (COVID-19). The aim of the present study was to evaluate the importance of fluid balance in COVID-19 patients admitted to ICU and its association with Kidney replacement therapy and mortality. Observational study including individuals admitted to ICU patients with an ICU stay longer than 24 hours. Exclusion criteria were age under 18 years, chronic dialysis and individuals with cerebral death. Files were revised for patient clinical characteristics, fluid administration and balance, physiological and laboratory data, diagnoses, and given treatment using case report forms. Data on fluid balance were recorded from admission to day 7. Increased in fluids of at least 5 and 10% were considered as fluid overload. Special attention was given to death, need of invasive mechanical ventilation, vasopressor drugs and dialysis A total of 176 intensive care patients with COVID-19 were included. Mean age was 58.7 (SD 15.4) years, and male to female ratio was almost 1. Most patient died (N 97, 55.1%), Kidney replacement therapy was performed in 32 (18.2%), invasive mechanical ventilation in 159 (90.3 %) and vasopressor was used in 140 (79.5%) patients. Mortality was increased in patients with a higher positive fluid balance. Median daily fluid balance was higher in non survivors than survivors, in dialysis than non-dialysis patients and in patients receiving invasive mechanical ventilation. Fluid overload defined with a threshold of 10% and 5% were used to design survival curves for mortality and for starting dialysis. Death and the probability of receiving dialysis were increases with fluid overload above 10 and 5%. In conclusion the present study shows that positive fluid balance in intensive care patients with COVID-19 is associated with mortality and need of Kidney replacement therapy and invasive mechanical ventilation. We are not aware of other studies disclosing such association in patients with SARS-CoV-2 infection in ICU. Further work is needed to evaluate if preventive measures to reduce fluid balance, restrictive fluid resuscitation, use of diuretics, or early kidney replacement therapy to treat fluid overload are effective in reducing mortality and morbidity.Controle da volemia em Unidades de Tratamento Intensivo (UTI) é essencial para o tratamento dos pacientes, e balanço hídrico tem sido considerado como um biomarcador em doentes críticos. Associação entre balanço hídrico positivo e mortalidade tem sido relatada, porém o impacto do balanço hídrico e sobrecarga de volume não foram avaliados em pacientes com a doença pelo coronavírus 2019 (COVID-19). O objetivo foi avaliar a importância do balanço hídrico em pacientes com COVID-19 internados em UTI e avaliar possíveis associações com mortalidade e diálise. Estudo observacional incluindo participantes baixados em UTI por pelo menos 24 horas. Pacientes com menos de 18 anos, em diálise crônica ou em morte cerebral foram excluídos. Os prontuários foram revisados buscando as características clínica, balanço hídrico, dados laboratoriais, fisiológicos, diagnósticos e tratamento usando um formulário. Os dados sobre o balanço hídrico foram coletados do dia da admissão até o dia 7. Aumento de fluidos de pelo menos 5 e 10% foram considerados como sobrecarga de volume. Atenção especial foi dada para morte, ventilação mecânica invasiva, uso de vasopressores e diálise. Foram incluídos 176 pacientes de UTI com COVID-19. A idade média era 58,7 (DP 15.4) anos, e a relação homens/mulheres de quase 1. A maioria dos pacientes morreram (N 97, 55,1%), dialise foi feita em 32 (18,2%), ventilação mecânica invasiva em 159 (90,3 %) e vasopressor foi empregado em 140 (79,5%) pacientes. A mortalidade foi aumentada em pacientes com maior positividade no balanço hídrico. A mediana do balanço hídrico foi maior em não sobreviventes do que sobreviventes, nos pacientes que precisaram de diálise do que naqueles que não necessitaram e nos que receberam ventilação mecânica invasiva. Morte e a probabilidade de diálise foram aumentadas nos pacientes com sobrecarga de volume de pelo menos 10 e 5%. O presente estudo mostra que balanço hídrico positivo em pacientes de UTI com COVID-19 está associado com mortalidade e necessidade de diálise e ventilação mecânica invasiva. Não estamos cientes de nenhum outro estudo mostrando esta associação em pacientes com COVID-19. Serão necessários outros ensaios para mostrar se medidas preventivas para reduzir o balanço hídrico, ressuscitação volêmica restritiva, uso de diuréticos ou diálise precoce para tratar sobrecarga serão efetivas para reduzir morbidade e mortalidade.Submitted by PPG Medicina e Ciências da Saúde (medicina-pg@pucrs.br) on 2021-11-11T12:23:40Z No. of bitstreams: 1 Versão Final - Greiciane.pdf: 1277151 bytes, checksum: fa7de3876c6d604302b0f8a9a6b34cc8 (MD5)Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2021-11-11T17:54:45Z (GMT) No. of bitstreams: 1 Versão Final - Greiciane.pdf: 1277151 bytes, checksum: fa7de3876c6d604302b0f8a9a6b34cc8 (MD5)Made available in DSpace on 2021-11-11T18:08:13Z (GMT). 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dc.title.por.fl_str_mv Balanço hídrico e desfechos adversos em pacientes com Covid-19 em unidade de terapia intensiva
title Balanço hídrico e desfechos adversos em pacientes com Covid-19 em unidade de terapia intensiva
spellingShingle Balanço hídrico e desfechos adversos em pacientes com Covid-19 em unidade de terapia intensiva
Rocha, Greiciane Gonçalves Carati da
Insuficiência Renal
Balanço Hídrico
Unidade de Terapia Intensiva Adulto
Cuidados Intensivos
Mortalidade
Cuidados de Enfermagem
Equilíbrio Hidroeletrolítico
SARS-CoV-2
Renal Insufficiency
Hydrologic Balance
Intensive Care Units
Critical Care
Mortality
Nursing Care
Water-Electrolyte Balance
SARS-CoV-2
CIENCIAS DA SAUDE::MEDICINA
title_short Balanço hídrico e desfechos adversos em pacientes com Covid-19 em unidade de terapia intensiva
title_full Balanço hídrico e desfechos adversos em pacientes com Covid-19 em unidade de terapia intensiva
title_fullStr Balanço hídrico e desfechos adversos em pacientes com Covid-19 em unidade de terapia intensiva
title_full_unstemmed Balanço hídrico e desfechos adversos em pacientes com Covid-19 em unidade de terapia intensiva
title_sort Balanço hídrico e desfechos adversos em pacientes com Covid-19 em unidade de terapia intensiva
author Rocha, Greiciane Gonçalves Carati da
author_facet Rocha, Greiciane Gonçalves Carati da
author_role author
dc.contributor.advisor1.fl_str_mv Figueiredo , Carlos Eduardo Poli de
dc.contributor.advisor1Lattes.fl_str_mv http://lattes.cnpq.br/7183837354797239
dc.contributor.authorLattes.fl_str_mv http://lattes.cnpq.br/0239870145053601
dc.contributor.author.fl_str_mv Rocha, Greiciane Gonçalves Carati da
contributor_str_mv Figueiredo , Carlos Eduardo Poli de
dc.subject.por.fl_str_mv Insuficiência Renal
Balanço Hídrico
Unidade de Terapia Intensiva Adulto
Cuidados Intensivos
Mortalidade
Cuidados de Enfermagem
Equilíbrio Hidroeletrolítico
SARS-CoV-2
topic Insuficiência Renal
Balanço Hídrico
Unidade de Terapia Intensiva Adulto
Cuidados Intensivos
Mortalidade
Cuidados de Enfermagem
Equilíbrio Hidroeletrolítico
SARS-CoV-2
Renal Insufficiency
Hydrologic Balance
Intensive Care Units
Critical Care
Mortality
Nursing Care
Water-Electrolyte Balance
SARS-CoV-2
CIENCIAS DA SAUDE::MEDICINA
dc.subject.eng.fl_str_mv Renal Insufficiency
Hydrologic Balance
Intensive Care Units
Critical Care
Mortality
Nursing Care
Water-Electrolyte Balance
SARS-CoV-2
dc.subject.cnpq.fl_str_mv CIENCIAS DA SAUDE::MEDICINA
description Volume control in intensive care unit (ICU) is essential for the management of patients, and fluid balance has been suggested a valuable biomarker of critical illness. A positive association between positive fluid balance and mortality has been reported, but the impact of fluid balance and fluid overload has not been evaluated in patients with coronavirus disease 2019 (COVID-19). The aim of the present study was to evaluate the importance of fluid balance in COVID-19 patients admitted to ICU and its association with Kidney replacement therapy and mortality. Observational study including individuals admitted to ICU patients with an ICU stay longer than 24 hours. Exclusion criteria were age under 18 years, chronic dialysis and individuals with cerebral death. Files were revised for patient clinical characteristics, fluid administration and balance, physiological and laboratory data, diagnoses, and given treatment using case report forms. Data on fluid balance were recorded from admission to day 7. Increased in fluids of at least 5 and 10% were considered as fluid overload. Special attention was given to death, need of invasive mechanical ventilation, vasopressor drugs and dialysis A total of 176 intensive care patients with COVID-19 were included. Mean age was 58.7 (SD 15.4) years, and male to female ratio was almost 1. Most patient died (N 97, 55.1%), Kidney replacement therapy was performed in 32 (18.2%), invasive mechanical ventilation in 159 (90.3 %) and vasopressor was used in 140 (79.5%) patients. Mortality was increased in patients with a higher positive fluid balance. Median daily fluid balance was higher in non survivors than survivors, in dialysis than non-dialysis patients and in patients receiving invasive mechanical ventilation. Fluid overload defined with a threshold of 10% and 5% were used to design survival curves for mortality and for starting dialysis. Death and the probability of receiving dialysis were increases with fluid overload above 10 and 5%. In conclusion the present study shows that positive fluid balance in intensive care patients with COVID-19 is associated with mortality and need of Kidney replacement therapy and invasive mechanical ventilation. We are not aware of other studies disclosing such association in patients with SARS-CoV-2 infection in ICU. Further work is needed to evaluate if preventive measures to reduce fluid balance, restrictive fluid resuscitation, use of diuretics, or early kidney replacement therapy to treat fluid overload are effective in reducing mortality and morbidity.
publishDate 2021
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