Effect of Slower vs Faster Intravenous Fluid Bolus Rates on Mortality in Critically Ill Patients

医学随机对照试验重症监护室病危麻醉生理盐水丸（消化）死亡率临床终点器官功能障碍重症监护医学重症监护外科内科学败血症

作者

Fernando G. Zampieri,Flávia Ribeiro Machado,Anders Larsson,Flávio César Freitas Vieira,Viviane Cordeiro Veiga,Rodrigo C. Figueiredo,Wilson José Lovato,Cristina Prata Amêndola,Murillo Santucci César de Assunção,Ary Serpa Neto,Jorge L. R. Paranhos,José Andrade,Michele Maria Gonçalves de Godoy,Edson Romano,Felipe Dal‐Pizzol,Emerson Barbosa da Silva,Miquéias M.L. Silva,Miriam Machado,Luíz Marcelo Sá Malbouisson,Airton L. O. Manoel,Marlus M. Thompson,Lanese Medeiros de Figueiredo,Rafael Marques Soares,Tamiris Abait Miranda,Lucas Mori de Lima,Eliana Vieira Santucci,Thiago Domingos Corrêa,Luciano César Pontes Azevedo,John A. Kellum,Lucas Petri Damiani,Nilton B. Silva,Alexandre Biasi Cavalcanti,Anders Larsson,Bruno C. R. Amaral,Edvar Ferreira R.,Andrea Z. Abdalla,Flávio Geraldo Rezende Freitas,Nathaly Fonseca Nunes,Rodrigo C. da Cunha,Elijane F. Alves,Rodrigo C. Figueiredo,Rodrigo B. Bortolini,Cintia L. Sartori,Eduardo S. Marques,Maria Auxiliadora de Sousa,Danieri Y. V. Tomotani,Airton L. O. Manoel,Wilson José Lovato,Bruno G. Dantas,Leonardo Carvalho Palma,Fabio Laurindo Silva,Cristina Prata Amêndola,Luciana Coelho Sanches,Fernanda A. M. Scuoteguazza,Ligia Z. de Britto,Ary Serpa,Niklas Söderberg Campos,Fábio Barlem Hohmann,Guilherme Benfatti Olivato,Jorge L. R. Paranhos,Iany G. da Silva,Adilson de C. Meireles,Viviane Cordeiro Veiga,Juliana Chaves Coelho,Maiko Moura Silveira,Agnes C. Lisboa,Marco A.V. Guedes,Luiz Carlos Santana Passos,Daniela C. Dorta,Ramana A. Rangel,Péricles Almeida Delfino Duarte,Eraldo de Azevedo Lúcio,Eduardo B. Tondo,Pablo A.A. Vaz,Paula K. de Oliveira,Lúcio Couto de Oliveira,Paulo H.P. Ferreira,Patrick Harrison Santana Sampaio,Maurício G.S. Serra,Thiago Lisboa,Caroline Fachini,André P. Torelly,Alldren Souza,Fábio Holanda Lacerda,Eliana V. N. Martins,Bruno Adler Maccagnan Pinheiro Besen,Carlos Eduardo Brandão,João Manoel Silva,Flávio W.F. Melo,Flávio A. dos Santos,Israel Silva Maia,Cássio Luis Zandonai,Eduardo Berbigier,Cíntia Magalhães Carvalho Grion,Josiane Festti,Ana Luiza Mezzaroba,José Andrade,Marianne Camargo,Adriano F. Teixeira,José Andrade,Michele Maria Gonçalves de Godoy,Andréia de F. T. de Mendonça,Mara L.F.S. Mendes,Renata C.I.C. Beltrão,Edson Romano,Marcelo Luz Pereira Romano,André Falcão Pedrosa Costa,Jorge Farran,Felipe Dal‐Pizzol,Danusa Damásio,Renata Casagrande Gonçalves,Emerson Boschi,Luiz de F. Ferreira,Robert Costa,Kellen Lopes,Miquéias M.L. Silva,Douglas L.A.B. de Matos,Renata de A. Marques,Glauco Adrieno Westphal,Miriam Machado,J. Ramos,Luíz Marcelo Sá Malbouisson,Bruno N. Lucena,Marlus M. Thompson,Lanese Medeiros de Figueiredo,Luana Feitosa Mourão,Thiago Santos Garcês,Israel da S. Maia,Jaqueline F. Rohr,Fernanda Fontanela,Cassia P. B. Martins,Álvaro Réa-Neto,Fernanda Baeumle Reese,Mirella Cristine de Oliveira,André Luiz Nunes Gobatto,Luciana S. de Mattos,Carolaine B. de Oliveira,Meton S. de Alencar,Jussara A. Arraes,João G.T. Alves,Thiago C. De Morais,Antônio A. P. Fagundes,Roberta T. Tallarico,Thais Coutinho,Ronald Torres,Fernando José Ramos,Fernanda C. Athalla,Mauricio H.C. dos Santos,Paulo Maurício Garcia Nosé,Cássia Righy Shinotsuka,Pedro Kurtz,Bruno Guimarães,Luciana Guilhermino Pereira,Raquel B. Jupato,Bruno de Arruda Bravim,Marcos Freitas Knibel,Allan S. da Silva,Vinícius G. de Luca,Niklas Soderberg,Roseny dos Reis Rodrigues,Luis E.P. Pfingsten,Cassiano Teixeira,José H.D. Barth,Giselle C. Pratini,Luiz Dalfior,Márcio H. Kai,S Blecher,Hugo C. A. Urbano,Lucas L. Carvalho,Danielle C. A. Moreira,Ana L. S. Bernardes,Vandack Nobre,Paula Frizera Vassallo,Cecilia Gómez Ravetti,Ho Y. Li,Vivian Vieira Tenório Sales,Renata Guazzelli,Rafael David de Oliveira,Leandro Pozzo,Leandro Utino Taniguchi,Pedro Vitale Mendes,Suzana M Lobo,Miriam Machado,Ana B. B. Camacho,Pablo Oscar Tomba,Fred C. T. Lizidatti,Walter C. G. Baptista,Aline R. Moreira,Manoela M. de Sousa,Marcelo de Oliveira Santos,Karla Moretto,Priscilla A. de Martins,Liz M. L. de Souza,Thiago R. Sequeira,Manoel M. S. Pedrinha,Marcone L. S. da Rocha,Francisco R. V. Saleiro,Tatiana M. Clementino,Hélio Penna Guimarães,Marcos Cesar Ramos Mello,Mirella Cristine de Oliveira,Fernanda Baeumle Reese,Denise Milioli Ferreira,Fernanda Alves Ferreira Gonçalves,Roberta Muriel Longo Roepke,Bruno Martins Tomazini,Thiago Martins Santos,Miria Bonjour Laviola,Thiago Domingos Corrêa,Roger Monteiro Alencar,Denise N. Freitas,Heitor P. Póvoas,Liliane B. S. Passos,Juliane de M. Silva

出处

期刊：JAMA [American Medical Association]
日期：2021-08-10 卷期号：326 (9): 830-830 被引量：39

链接

jamanetwork.com nih.gov nih.govdoi.org

标识

DOI：10.1001/jama.2021.11444

摘要

Importance

Slower intravenous fluid infusion rates could reduce the formation of tissue edema and organ dysfunction in critically ill patients; however, there are no data to support different infusion rates during fluid challenges for important outcomes such as mortality.

Objective

To determine the effect of a slower infusion rate vs control infusion rate on 90-day survival in patients in the intensive care unit (ICU).

Design, Setting, and Participants

Unblinded randomized factorial clinical trial in 75 ICUs in Brazil, involving 11 052 patients requiring at least 1 fluid challenge and with 1 risk factor for worse outcomes were randomized from May 29, 2017, to March 2, 2020. Follow-up was concluded on October 29, 2020. Patients were randomized to 2 different infusion rates (reported in this article) and 2 different fluid types (balanced fluids or saline, reported separately).

Interventions

Patients were randomized to receive fluid challenges at 2 different infusion rates; 5538 to the slower rate (333 mL/h) and 5514 to the control group (999 mL/h). Patients were also randomized to receive balanced solution or 0.9% saline using a factorial design.

Main Outcomes and Measures

The primary end point was 90-day survival.

Results

Of all randomized patients, 10 520 (95.2%) were analyzed (mean age, 61.1 years [SD, 17.0 years]; 44.2% were women) after excluding duplicates and consent withdrawals. Patients assigned to the slower rate received a mean of 1162 mL on the first day vs 1252 mL for the control group. By day 90, 1406 of 5276 patients (26.6%) in the slower rate group had died vs 1414 of 5244 (27.0%) in the control group (adjusted hazard ratio, 1.03; 95% CI, 0.96-1.11;P = .46). There was no significant interaction between fluid type and infusion rate (P = .98).

Conclusions and Relevance

Among patients in the intensive care unit requiring fluid challenges, infusing at a slower rate compared with a faster rate did not reduce 90-day mortality. These findings do not support the use of a slower infusion rate.

Trial Registration

ClinicalTrials.gov Identifier:NCT02875873

求助该文献

最长约 10秒，即可获得该文献文件