[The impact of early restrictive positive fluid balance strategy on the prognosis of patients with severe trauma].

Abstract

OBJECTIVE:

To observe the impact of early restrictive positive fluid balance strategy on the prognosis of patients with trauma.

METHODS:

A prospective controlled study was conducted. The patients with severe post-trauma capillary leak syndrome (PTCLS) admitted to department of critical care medicine of the Fifth Center Hospital in Tianjin were considered as study object. Fluid treatment was adjusted according to intra-thoracic blood volume index (ITBVI), mean arterial pressure (MAP), cardiac index (CI) and oxygen saturation of central vein (ScvO2) at leakage stage of PTCLS. Patients were divided into two groups according to different fluid therapy volume, restrictive positive fluid balance group (restrictive group) and non-restrictive positive fluid balance group (non-restrictive group), 30 patients were enrolled into each group. The fluid balance volume and index of prognosis between two groups were analyzed within 7 days of treatment.

RESULTS:

During the leakage stage of PTCLS, compared with non-restrictive group, fluid positive volume of the restrictive group were decreased at 1-6 days of the treatment (1 day: 5968.8±1818.0 ml/d vs. 7109.7±2186.41 ml/d, 2 days: 3653.7±1525.1 ml/d vs. 6080.3±1538.8 ml/d, 3 days: 1953.6±621.3 ml/d vs. 3223.3±875.1 ml/d, 4 days: -2808.7±888.0 ml/d vs. -4169.9±1302.5 ml/d, 5 days: -5969.1±1470.8 ml/d vs. -6896.5±1619.4 ml/d, 6 days: -1938.1±746.0 ml/d vs. -4964.0±1389.6 ml/d, P<0.05 or P<0.01), ITBVI and extravascular lung water index (EVLWI) were decreased at 2 days and 3 days of the treatment (ITBVI 2 days: 689.2±60.6 ml/m(2) vs. 807.7±67.8 ml/m(2), 3 days: 729.6±43.3 ml/m(2) vs. 825.5±71.5 ml/m(2); EVLWI 2 days: 6.9±2.0 ml/kg vs. 8.3±2.1 ml/kg, 3 days: 7.6±2.0 ml/kg vs. 8.9±1.9 ml/kg, P<0.05 or P<0.01). Compared with non-restrictive group, the occurrence of respiratory dysfunction (46.7% vs. 76.7%), gastrointestinal dysfunction (33.3% vs. 60.0%) and the occurrence of intracranial hypertension (26.7% vs. 56.7%) at 7 days of treatment in restrictive group were decreased (all P<0.05), the time of mechanical ventilation (3.6±1.1 days vs. 5.1±1.5 days) and intensive care unit (ICU) stay time (5.5±1.5 days vs. 7.0±1.9 days) were shortened (both P<0.01). There were no differences in the occurrence of dysfunction of cardiovascular, blood coagulation, hepatic and renal function, the percentage of patients receiving renal-replacement therapy and the number of days with dialysis, as well as the mortality during the first 28 days between two groups (all P>0.05).

CONCLUSION:

Using restrictive positive fluid balance strategy in the leakage stage of PTCLS, fluid positive balance volume, occurrence of dysfunction of some organs, mechanical ventilation and ICU stay time can be decreased.

• Authors: Wan-jie Yang, Qing-guo Feng, Kai Wei, Wei Wang, Xue-feng Zhao, Chang Li, Xiu-ling Cheng
• Journal: Zhonghua wei zhong bing ji jiu yi xue (Zhonghua Wei Zhong Bing Ji Jiu Yi Xue) Vol. 25 Issue 1 Pg. 36-9 (Jan 2013) ISSN: 2095-4352 [Print] China
• PMID: 23611095 (Publication Type: Controlled Clinical Trial, English Abstract, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Capillary Leak Syndrome (therapy)
• Critical Illness
• Female
• Fluid Therapy
• Humans
• Male
• Prognosis
• Prospective Studies
• Water-Electrolyte Balance
• Wounds and Injuries (therapy)
• Young Adult