A Prospective Observational Study of Rational Fluid Therapy in Asian Intensive Care Units: Another Puzzle Piece in Fluid Therapy

JOURNAL TITLE: Indian Journal of Critical Care Medicine

Author
1. Matthias Jacob
2. Kuang-Yao Yang
3. Yogendra P Singh
4. Farooq Memom
5. Hugo Van Aken
6. Rajesh Chawla
7. Shuenn-Wen Kuo
8. Tan C Cheng
9. Amit Mandal
10. Nirmal Jaiswal
11. Mohan Mathew
12. Shanti R Deva
13. Luah Wah
14. Vineya Rai
15. Jayant Shelgaokar
16. ZA Khan
17. Bernhard Zwissler
18. Pravin Amin
19. JV Divatia
20. Gopinath Ramachandran
ISSN
0972-5229
DOI
10.5005/jp-journals-10071-23653
Volume
24
Issue
11
Publishing Year
2020
Pages
9
Author Affiliations
    1. Department of Anesthesiology and Surgical Intensive Care, St. Elisabeth Hospital, Straubing, Germany
    1. Department of Critical Care Medicine, Max Super Specialty Hospital, Patparganj, New Delhi, India
    1. Department of Chest Medicine, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan
    1. National Taiwan University Hospital, Taipei City, Taiwan
    1. Rajasthan Hospital, Ahmedabad, Gujarat, India
    1. Suretech Hospital, Dhantoli, Maharashtra, India
    2. Suretech Hospital, Nagpur; Wockhardt Hospital Nagpur, Maharashtra, India
    3. Suretech Hospital and Research Center, Wockhardt Multispeciality Hospital, Nagpur, Maharashtra, India
    1. Sultanah Aminah Hospital, Johor Bahru, Johor, Malaysia
    1. Department of Pulmonology and Critical Care, MICU, Fortis Hospital, Mohali, Punjab, India
    1. Jalan Pahang, Kuala Lumpur, Malaysia
    1. Lakeshore Hospital and Research Centre, Kochi, Kerala, India
    1. Department of Anesthesiology, KPJ Tawakkal Specialist Hospital, Jalan Pahang Barat, Kuala Lumpur, Malaysia
    1. Jalan Residensi, Pulau Pinang, Malaysia
    1. Nizam’s, Institute of Medical Sciences, Hyderabad, Telangana, India
    1. Indraprastha Apollo Hospital, New Delhi, India
    2. Indraprastha Apollo Hospitals, New Delhi, India
    3. Indraprashtha Apollo Hospital, New Delhi, India
    1. Noble Hospital, Pune, Maharashtra, India
    1. Critical Care and Pain, Tata Memorial Hospital, Parel, Mumbai, Maharashtra (India)
    2. Tata Memorial Hospital, Parel (E), Mumbai 400 012 (India)
    3. Tata Memorial Hospital, Parel, Mumbai
    4. Tata Memorial Hospital, Mumbai, Maharashtra, India
    5. Tata Memorial Hospital, Mumbai, India
    6. Tata Memorial Centre, Mumbai, Maharashtra, India
    7. Tata Memorial Hospital, Mumbai, Maharashtra, India; Indian Society of Critical Care Medicine
    1. Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
    2. Bombay Hospital, Mumbai, Maharashtra, India
    1. Department of Critical Care, Aditya Birla Memorial Hospital, Aditya Birla Hospital Marg, Pune, Maharashtra, India
    1. Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
    1. Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
  • Article keywords

    Abstract

    Introduction: Fluid therapy in critically ill patients, especially timing and fluid choice, is controversial. Previous randomized trials produced conflicting results. This observational study evaluated the effect of colloid use on 90-day mortality and acute kidney injury (RIFLE F) within the Rational Fluid Therapy in Asia (RaFTA) registry in intensive care units. Materials and methods: RaFTA is a prospective, observational study in Asian intensive care unit (ICU) patients focusing on fluid therapy and related outcomes. Logistic regression was performed to identify risk factors for increased 90-day mortality and acute kidney injury (AKI). Results: Twenty-four study centers joined the RaFTA registry and collected 3,187 patient data sets from November 2011 to September 2012. A follow-up was done 90 days after ICU admission. For 90-day mortality, significant risk factors in the overall population were sepsis at admission (OR 2.185 [1.799; 2.654], p < 0.001), cumulative fluid balance (OR 1.032 [1.018; 1.047], p < 0.001), and the use of vasopressors (OR 3.409 [2.694; 4.312], p < 0.001). The use of colloids was associated with a reduced risk of 90-day mortality (OR 0.655 [0.478; 0.900], p = 0.009). The initial colloid dose was not associated with an increased risk for AKI (OR 1.094 [0.754; 1.588], p = 0.635). Conclusion: RaFTA adds the important finding that colloid use was not associated with increased 90-day mortality or AKI after adjustment for baseline patient condition. Clinical significance: Early resuscitation with colloids showed potential mortality benefit in the present analysis. Elucidating these findings may be an approach for future research.

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