Impact of protocolized diuresis for de-resuscitation in the intensive care unit
Abstract Objective Administration of diuretics has been shown to assist fluid management and improve clinical outcomes in the critically ill post-shock resolution. Current guidelines have not yet included standardization or guidance for diuretic-based de-resuscitation in critically ill patients. Thi...
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| Format: | Article |
| Language: | English |
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BMC
2020-02-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13054-020-2795-9 |
| _version_ | 1819081307357970432 |
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| author | Brittany D. Bissell Melanie E. Laine Melissa L. Thompson Bastin Alexander H. Flannery Andrew Kelly Jeremy Riser Javier A. Neyra Jordan Potter Peter E. Morris |
| author_facet | Brittany D. Bissell Melanie E. Laine Melissa L. Thompson Bastin Alexander H. Flannery Andrew Kelly Jeremy Riser Javier A. Neyra Jordan Potter Peter E. Morris |
| author_sort | Brittany D. Bissell |
| collection | DOAJ |
| description | Abstract Objective Administration of diuretics has been shown to assist fluid management and improve clinical outcomes in the critically ill post-shock resolution. Current guidelines have not yet included standardization or guidance for diuretic-based de-resuscitation in critically ill patients. This study aimed to evaluate the impact of a multi-disciplinary protocol for diuresis-guided de-resuscitation in the critically ill. Methods This was a pre-post single-center pilot study within the medical intensive care unit (ICU) of a large academic medical center. Adult patients admitted to the Medical ICU receiving mechanical ventilation with either (1) clinical signs of volume overload via chest radiography or physical exam or (2) any cumulative fluid balance ≥ 0 mL since hospital admission were eligible for inclusion. Patients received diuresis per clinician discretion for a 2-year period (historical control) followed by a diuresis protocol for 1 year (intervention). Patients within the intervention group were matched in a 1:3 ratio with those from the historical cohort who met the study inclusion and exclusion criteria. Results A total of 364 patients were included, 91 in the protocol group and 273 receiving standard care. Protocolized diuresis was associated with a significant decrease in 72-h post-shock cumulative fluid balance [median, IQR − 2257 (− 5676–920) mL vs 265 (− 2283–3025) mL; p < 0.0001]. In-hospital mortality in the intervention group was lower compared to the historical group (5.5% vs 16.1%; p = 0.008) and higher ICU-free days (p = 0.03). However, no statistically significant difference was found in ventilator-free days, and increased rates of hypernatremia and hypokalemia were demonstrated. Conclusions This study showed that a protocol for diuresis for de-resuscitation can significantly improve 72-h post-shock fluid balance with potential benefit on clinical outcomes. |
| first_indexed | 2024-12-21T19:58:42Z |
| format | Article |
| id | doaj.art-0294df5ba925468196988b92bb9db68f |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-21T19:58:42Z |
| publishDate | 2020-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-0294df5ba925468196988b92bb9db68f2022-12-21T18:52:02ZengBMCCritical Care1364-85352020-02-0124111010.1186/s13054-020-2795-9Impact of protocolized diuresis for de-resuscitation in the intensive care unitBrittany D. Bissell0Melanie E. Laine1Melissa L. Thompson Bastin2Alexander H. Flannery3Andrew Kelly4Jeremy Riser5Javier A. Neyra6Jordan Potter7Peter E. Morris8Department of Pharmacy Services, Neuro-Pulmonary Division, University of KentuckyDepartment of Pharmacy Services, Neuro-Pulmonary Division, University of KentuckyDepartment of Pharmacy Services, Neuro-Pulmonary Division, University of KentuckyDepartment of Pharmacy Services, Neuro-Pulmonary Division, University of KentuckyPerformance Analytics Center of Excellence, University of KentuckyPerformance Analytics Center of Excellence, University of KentuckyCollege of Medicine, Department of Internal Medicine, Bone and Mineral Metabolism, University of KentuckyDepartment of Pharmacy Services, Beaumont HospitalCollege of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of KentuckyAbstract Objective Administration of diuretics has been shown to assist fluid management and improve clinical outcomes in the critically ill post-shock resolution. Current guidelines have not yet included standardization or guidance for diuretic-based de-resuscitation in critically ill patients. This study aimed to evaluate the impact of a multi-disciplinary protocol for diuresis-guided de-resuscitation in the critically ill. Methods This was a pre-post single-center pilot study within the medical intensive care unit (ICU) of a large academic medical center. Adult patients admitted to the Medical ICU receiving mechanical ventilation with either (1) clinical signs of volume overload via chest radiography or physical exam or (2) any cumulative fluid balance ≥ 0 mL since hospital admission were eligible for inclusion. Patients received diuresis per clinician discretion for a 2-year period (historical control) followed by a diuresis protocol for 1 year (intervention). Patients within the intervention group were matched in a 1:3 ratio with those from the historical cohort who met the study inclusion and exclusion criteria. Results A total of 364 patients were included, 91 in the protocol group and 273 receiving standard care. Protocolized diuresis was associated with a significant decrease in 72-h post-shock cumulative fluid balance [median, IQR − 2257 (− 5676–920) mL vs 265 (− 2283–3025) mL; p < 0.0001]. In-hospital mortality in the intervention group was lower compared to the historical group (5.5% vs 16.1%; p = 0.008) and higher ICU-free days (p = 0.03). However, no statistically significant difference was found in ventilator-free days, and increased rates of hypernatremia and hypokalemia were demonstrated. Conclusions This study showed that a protocol for diuresis for de-resuscitation can significantly improve 72-h post-shock fluid balance with potential benefit on clinical outcomes.http://link.springer.com/article/10.1186/s13054-020-2795-9Critical illnessDiureticsResuscitationFluid therapyPharmacistsMechanical ventilation |
| spellingShingle | Brittany D. Bissell Melanie E. Laine Melissa L. Thompson Bastin Alexander H. Flannery Andrew Kelly Jeremy Riser Javier A. Neyra Jordan Potter Peter E. Morris Impact of protocolized diuresis for de-resuscitation in the intensive care unit Critical Care Critical illness Diuretics Resuscitation Fluid therapy Pharmacists Mechanical ventilation |
| title | Impact of protocolized diuresis for de-resuscitation in the intensive care unit |
| title_full | Impact of protocolized diuresis for de-resuscitation in the intensive care unit |
| title_fullStr | Impact of protocolized diuresis for de-resuscitation in the intensive care unit |
| title_full_unstemmed | Impact of protocolized diuresis for de-resuscitation in the intensive care unit |
| title_short | Impact of protocolized diuresis for de-resuscitation in the intensive care unit |
| title_sort | impact of protocolized diuresis for de resuscitation in the intensive care unit |
| topic | Critical illness Diuretics Resuscitation Fluid therapy Pharmacists Mechanical ventilation |
| url | http://link.springer.com/article/10.1186/s13054-020-2795-9 |
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