Balanço hídrico e desfechos adversos em pacientes com Covid-19 em unidade de terapia intensiva
Autor(a) principal: | |
---|---|
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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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). No. of bitstreams: 1 Versão Final - Greiciane.pdf: 1277151 bytes, checksum: fa7de3876c6d604302b0f8a9a6b34cc8 (MD5) Previous issue date: 2021-08-31Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESapplication/pdfhttp://tede2.pucrs.br:80/tede2/retrieve/182578/DIS_GREICIANE_GONCALVES_CARATI_CONFIDENCIAL.pdf.jpgporPontifícia Universidade Católica do Rio Grande do SulPrograma de Pós-Graduação em Medicina e Ciências da SaúdePUCRSBrasilEscola de MedicinaInsuficiência RenalBalanço HídricoUnidade de Terapia Intensiva AdultoCuidados IntensivosMortalidadeCuidados de EnfermagemEquilíbrio HidroeletrolíticoSARS-CoV-2Renal InsufficiencyHydrologic BalanceIntensive Care UnitsCritical CareMortalityNursing CareWater-Electrolyte BalanceSARS-CoV-2CIENCIAS DA SAUDE::MEDICINABalanço hídrico e desfechos adversos em pacientes com Covid-19 em unidade de terapia intensivainfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisTrabalho será publicado como artigo ou livro60 meses11/11/2026-721401722658532398500500500600-224747486637135387-9693694523087866273590462550136975366info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da PUC_RSinstname:Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)instacron:PUC_RSTHUMBNAILDIS_GREICIANE_GONCALVES_CARATI_CONFIDENCIAL.pdf.jpgDIS_GREICIANE_GONCALVES_CARATI_CONFIDENCIAL.pdf.jpgimage/jpeg4077http://tede2.pucrs.br/tede2/bitstream/tede/9966/4/DIS_GREICIANE_GONCALVES_CARATI_CONFIDENCIAL.pdf.jpgd4811e87072e3978845a8c22dfc52d84MD54TEXTDIS_GREICIANE_GONCALVES_CARATI_CONFIDENCIAL.pdf.txtDIS_GREICIANE_GONCALVES_CARATI_CONFIDENCIAL.pdf.txttext/plain1530http://tede2.pucrs.br/tede2/bitstream/tede/9966/3/DIS_GREICIANE_GONCALVES_CARATI_CONFIDENCIAL.pdf.txt306e0c925c5c531854de2cdfe7214116MD53ORIGINALDIS_GREICIANE_GONCALVES_CARATI_CONFIDENCIAL.pdfDIS_GREICIANE_GONCALVES_CARATI_CONFIDENCIAL.pdfapplication/pdf384704http://tede2.pucrs.br/tede2/bitstream/tede/9966/2/DIS_GREICIANE_GONCALVES_CARATI_CONFIDENCIAL.pdf0fecdfb2756e1a11e639a6c426a00a32MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-8590http://tede2.pucrs.br/tede2/bitstream/tede/9966/1/license.txt220e11f2d3ba5354f917c7035aadef24MD51tede/99662021-11-11 20:00:19.889oai:tede2.pucrs.br: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Biblioteca Digital de Teses e Dissertaçõeshttp://tede2.pucrs.br/tede2/PRIhttps://tede2.pucrs.br/oai/requestbiblioteca.central@pucrs.br||opendoar:2021-11-11T22:00:19Biblioteca Digital de Teses e Dissertações da PUC_RS - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)false |
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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2021-11-11T18:08:13Z |
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2021-08-31 |
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Pontifícia Universidade Católica do Rio Grande do Sul |
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