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Fluid Overload and Risk of Mortality in Critically Ill Patients
Jessica Gomes1, Marcele Liliane Pesavento, Flavia Fernandes Manfredi de Freitas
1Jessica Gomes, RN, is a registered nurse and student of the Multiprofessional Intensive Care Residency Program, Intensive Care Unit, Israelita Albert Einstein Hospital, São Paulo, Brazil. Ms. Gomes is a graduate student at the São José do Rio Preto School of Medicine - FAMERP (2016), with a stage abroad at York University - Toronto (Canada). Marcele Liliane Pesavento, RN, is a registered nurse and nursing coordinator of the Intensive Care Unit, Israelita Albert Einstein Hospital, São Paulo, Brazil. Mr. Pesavento is an executive MBA in management of clinics, hospitals and health industries from the Getúlio Vargas Foundation (FGV). He is an Extracorporeal Oxygen Membrane Specialist (ECMO) from Stollery Children's Hospital and the Heart Institute of Hospital das Clínicas, University of São Paulo (INCOR) (2015). He is currently a senior nurse at Israelita Albert Einstein Hospital. Flavia Fernandes Manfredi de Freitas, RP, is a registered physiotherapist. She is responsible for the Multiprofessional Intensive Care Residency Program, Intensive Care Unit, Israelita Albert Einstein Hospital, São Paulo, Brazil. Ms. de Freitas graduated in Physiotherapy from Universidade Paulista - UNIP. She is a specialist in Hospital Physiotherapy at Albert Einstein Institute of Education and Research - HIAE, Cardiovascular Rehabilitation by the Dante Pazzanese Institute of Cardiology (IDPC), and Health Quality Management from the Albert Einstein Institute of Education and Research - HIAE. Master in Physiotherapy from University of São Paulo/ UNICID in partnership with SEFICE Federal University of São Paulo - UNIFESP. MBA in Health Management from the University of São Paulo - USP. Tutor of the Multiprofessional Residence in the Intensive Care Unit of Hospital Israelita Albert Einstein. Filipe Utuari de Andrade Coelho, RN, MD, is a registered nurse, assistant professor of Nursing Graduation at the Health Sciences Faculty of Israelita Albert Einstein Hospital, São Paulo, Brazil. Dr. Coelho is a PhD student in Nursing in Adult Health by the School of Nursing of the University of São Paulo (EEUSP) (2019). He has a Master's Degree in Nursing in Adult Health by the School of Nursing of the University of São Paulo (EEUSP) (2018). He is a specialist in Extracorporeal Oxygen Membrane (ECMO) at Stollery Children's Hospital and the Heart Institute of the Clinical Hospital of the University of São Paulo (INCOR) (2015), and Intensive Care Unit, Institute of Israelita Albert Einstein Hospital (2014).
Background:
Fluid overload (FO) is a condition present in critical care units, and it is associated with clinical complications and worse outcomes for severe patients.
Objective:
The aim of this study was to verify if FO is a risk factor for mortality in critically ill patients.
Methods:
Retrospective study performed in a Brazilian intensive care unit, from January to March 2016, with patients older than 18 years and hospitalized for more than 24 hours. Demographic and clinical data, as well as fluid balance and overload, were analyzed to verify the risk factors for mortality. A logistic regression model was elaborated, and significance was set at P < .05.
Results:
There were 158 patients included, of which only 13 (8.2%) presented FO. Mortality was verified in individuals 30 (18.9%), of whom only 7 (23.3%) developed FO, which was lower in survivors 6 (4.9%), P = .001. In the simple regression model, the FO was significant (odds ratio [OR], 6.23; 95% confidence interval [CI], 2.04-19.53), P = .001. However, in the multiple regression model, there were significant findings only for mechanical ventilation (OR, 5.86; 95% CI, 2.10-18.12, P = .001), acute kidney injury (OR, 4.05; 95% CI, 1.53-11; P = .001), and noradrenaline (OR, 3.85; 95% CI, 1.01-9.51; P = .041); FO was not significant (OR, 3.68; 95% CI, 0.91-15.55; P = .069).
Conclusion:
Fluid overload is higher in patients who died. Therefore, it was not considered a risk factor for mortality.
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