Thummaporn Naorungroj1,2, Ary Serpa Neto1,3,4, Lara Zwakman-Hessels1,5, Fumitaka Yanase1,6, Glenn Eastwood1, Rinaldo Bellomo7,8,9. 1. Department of Intensive Care Medicine, Austin Hospital, Melbourne, Victoria, Australia. 2. Department of Intensive Care Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 3. Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil. 4. Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 5. Department of Critical Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 6. Australian and New Zealand Intensive Care Research Center, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia. 7. Department of Intensive Care Medicine, Austin Hospital, Melbourne, Victoria, Australia, rinaldo.bellomo@austin.org.au. 8. Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia, rinaldo.bellomo@austin.org.au. 9. Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Health, Melbourne, Victoria, Australia, rinaldo.bellomo@austin.org.au.
Abstract
INTRODUCTION: Little is known about early (first 48 h) hourly and cumulative fluid balance (FB) during continuous renal replacement therapy (CRRT). OBJECTIVES: To study the characteristics and outcome associations of early hourly and cumulative FB. METHODS: We studied FB in CRRT patients (2016-2018). RESULTS: Among 350 patients, mean hourly FB became negative after 20 CRRT hours, but within 6 CRRT hours in patients with baseline fluid overload. A negative early FB was never achieved in patients receiving vasopressor therapy (p < 0.001). Mortality was 31%. The percentage of hourly negative FB was independently associated with decreased ICU mortality. A time-weighted hourly FB between 18.5 and -33 mL/h was also significantly and independently associated with decreased mortality. CONCLUSIONS: In CRRT patients, an early FB conservative approach is possible, modulated by patient characteristics, and associated with a low mortality. Moreover, avoidance of an early positive FB is associated with decreased mortality.
INTRODUCTION: Little is known about early (first 48 h) hourly and cumulative fluid balance (FB) during continuous renal replacement therapy (CRRT). OBJECTIVES: To study the characteristics and outcome associations of early hourly and cumulative FB. METHODS: We studied FB in CRRT patients (2016-2018). RESULTS: Among 350 patients, mean hourly FB became negative after 20 CRRT hours, but within 6 CRRT hours in patients with baseline fluid overload. A negative early FB was never achieved in patients receiving vasopressor therapy (p < 0.001). Mortality was 31%. The percentage of hourly negative FB was independently associated with decreased ICU mortality. A time-weighted hourly FB between 18.5 and -33 mL/h was also significantly and independently associated with decreased mortality. CONCLUSIONS: In CRRT patients, an early FB conservative approach is possible, modulated by patient characteristics, and associated with a low mortality. Moreover, avoidance of an early positive FB is associated with decreased mortality.