Indian Journal of Critical Care Medicine

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VOLUME 24 , ISSUE 11 ( November, 2020 ) > List of Articles

RESEARCH ARTICLE

A Prospective Observational Study of Rational Fluid Therapy in Asian Intensive Care Units: Another Puzzle Piece in Fluid Therapy

Matthias Jacob, Sambit Sahu, Yogendra P Singh, Kuang-Yao Yang, Shuenn-Wen Kuo, Farooq Memom, Shirish Prayag, Nirmal Jaiswal, Tan C Cheng, Amit Mandal, Shanti R Deva, Mohan Mathew, Vineya Rai, Luah Wah, Gopinath Ramachandran, Rajesh Chawla, ZA Khan, JV Divatia, Rajesh Mishra, Pravin Amin, Jayant Shelgaokar, Bernhard Zwissler, Hugo Van Aken

Keywords : Acute kidney injury, Colloids, Critical illness, Crystalloids, Fluid therapy, Hydroxyethyl starch

Citation Information : Jacob M, Sahu S, Singh YP, Yang K, Kuo S, Memom F, Prayag S, Jaiswal N, Cheng TC, Mandal A, Deva SR, Mathew M, Rai V, Wah L, Ramachandran G, Chawla R, Khan Z, Divatia J, Mishra R, Amin P, Shelgaokar J, Zwissler B, Van Aken H. A Prospective Observational Study of Rational Fluid Therapy in Asian Intensive Care Units: Another Puzzle Piece in Fluid Therapy. Indian J Crit Care Med 2020; 24 (11):1028-1036.

DOI: 10.5005/jp-journals-10071-23653

License: CC BY-NC 4.0

Published Online: 16-12-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Fluid therapy in critically ill patients, especially timing and fluid choice, is controversial. Previous randomized trials produced conflicting results. This observational study evaluated the effect of colloid use on 90-day mortality and acute kidney injury (RIFLE F) within the Rational Fluid Therapy in Asia (RaFTA) registry in intensive care units. Materials and methods: RaFTA is a prospective, observational study in Asian intensive care unit (ICU) patients focusing on fluid therapy and related outcomes. Logistic regression was performed to identify risk factors for increased 90-day mortality and acute kidney injury (AKI). Results: Twenty-four study centers joined the RaFTA registry and collected 3,187 patient data sets from November 2011 to September 2012. A follow-up was done 90 days after ICU admission. For 90-day mortality, significant risk factors in the overall population were sepsis at admission (OR 2.185 [1.799; 2.654], p < 0.001), cumulative fluid balance (OR 1.032 [1.018; 1.047], p < 0.001), and the use of vasopressors (OR 3.409 [2.694; 4.312], p < 0.001). The use of colloids was associated with a reduced risk of 90-day mortality (OR 0.655 [0.478; 0.900], p = 0.009). The initial colloid dose was not associated with an increased risk for AKI (OR 1.094 [0.754; 1.588], p = 0.635). Conclusion: RaFTA adds the important finding that colloid use was not associated with increased 90-day mortality or AKI after adjustment for baseline patient condition. Clinical significance: Early resuscitation with colloids showed potential mortality benefit in the present analysis. Elucidating these findings may be an approach for future research.


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