Acute Crit Care.  2020 Aug;35(3):189-196. 10.4266/acc.2020.00031.

Association between postoperative fluid balance and mortality and morbidity in critically ill patients with complicated intra-abdominal infections: a retrospective study

• Sim J
• Kwak JY
• Jung YT

• KMID: 2506098
• DOI: http://doi.org/10.4266/acc.2020.00031

Abstract

Background
Postoperative fluid overload may increase the risk of developing pulmonary complications and other adverse outcomes. We evaluated the impact of excessive fluid administration on postoperative outcomes in critically ill patients.
Methods
We reviewed the medical records of 320 patients admitted to intensive care unit (ICU) after emergency abdominal surgery for complicated intra-abdominal infection (cIAI) between January 2013 and December 2018. The fluid balance data of the patients were reviewed for a maximum of 7 days. The patients were grouped based on average daily fluid balance with a cutoff value of 20 ml/kg/day. Propensity score matching was performed to reduce the underlying differences between the groups.
Results
Patients with an average daily fluid balance of ≥ 20 ml/kg/day were associated with higher rates of 30-day mortality (11.8% vs. 2.4%; P = 0.036) than those with lower fluid balance ( < 20 ml/kg/day). Kaplan-Meier survival curves for 30-day mortality in these groups also showed a better survival rate in the lower fluid balance group with a statistical significance (P = 0.020). The percentage of patients who developed pulmonary consolidation during ICU stay (47.1% vs. 24.7%; P = 0.004) was higher in the fluid-overloaded group. Percentages of newly developed pleural effusion (61.2% vs. 57.7%; P = 0.755), reintubation (18.8% vs. 10.6%; P = 0.194), and infectious complications (55.3% vs. 49.4%; P = 0.539) showed no significant differences between the two groups.
Conclusions
Postoperative fluid overload in patients who underwent emergency surgery for cIAI was associated with higher 30-day mortality and more frequent occurrence of pulmonary consolidation. Postoperative fluid balance should be adjusted carefully to avoid adverse clinical outcomes.

Keyword

complicated intra-abdominal infection; critically ill; fluid overload

Figure

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  Figure 1. Study population. GI: gastrointestinal; ICU: intensive care unit.

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  Figure 2. Kaplan-Meier survival curves for patients with different average daily fluid balance (after matching). The patients with an average daily fluid balance of <20 ml/kg showed a better survival curve during their hospital stay in the 30-day period than those who had an average daily fluid balance of ≥20 ml/kg (log-rank test, P=0.020).

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