Deniz UYSAL SÖNMEZ, Hulya DİROL, Abdullah ERDOĞAN

Sepsisli hastalarda sıvı dengesinin sonuçlara etkisi; üçüncü basamak bir hastane deneyimi

Amaç: Sıvı replasmanı, sepsiste hemodinamik durumu stabilize etmek için hayati öneme sahiptir. Bununla birlikte, pozitif sıvı dengesinin olumsuz etkileri olabilir.Gereç ve yöntem: Ağustos 2016-Nisan 2017 tarihleri arasında üçüncü basamak bir hastanede sepsise bağlı mekanik ventilasyonla desteklenen hastaları içeren tek merkezli, retrospektif bir çalışmadır. Demografik özellikler, ilaçlar, mekanik ventilasyon süresi, yoğun bakımda kalış süresi, kan biyokimyasal testleri, sıvı dengesi ile ilgili tüm veriler hasta dosyaları ve hemşire çizelgelerinden elde edildi. Hastalar sıvı dengesine göre pozitif, negatif ve dengeli olarak alt sınıflandırılarak birbirleriyle karşılaştırıldı.Bulgular: Çalışmaya toplam 50 sepsisli hasta alındı. Hastaların yirmi altısı (%52) erkekti ve yaş ortalaması 66,58±3,25 yıl idi. Ölüm oranı %90 idi. Ortalama sıvı alımı ve çıkışı sırasıyla 3481,8±1002,7, 1877,6±921,3 mililitre idi. Kırk ikisi (%84) pozitif sıvı dengesinde, 6'sı (%12) negatif sıvı dengesinde ve 2'si (%4) dengede idi. Sıvı dengesi alt grupları arasında yoğun bakımda kalış süresi, mekanik ventilasyon süresi ve mortalite açısından anlamlı fark yoktu. Pozitif sıvı dengesi olan hastalarda diüretik kullanımı anlamlı olarak daha yüksekti (p=0.023). Pozitif sıvı dengesi olan hastalarda CRP anlamlı olarak daha yüksek, serum albümini ise daha düşüktü (sırasıyla, p=0.003, p=0.034). Sağ kalanların ve sağ kalmayanların ortalama GCS, SOFA skorları arasında fark yoktu ancak sağ kalmayanlarda ortalama APACHE II skorları sağ kalanlardan anlamlı derecede yüksekti (p=0.026).Sonuç: Çalışmamız, pozitif sıvı dengesinin yoğun bakımda kalış süresi, mekanik ventilasyon süresi ve mortaliteyi etkilemediğini ve APACHE II'nin mortaliteyi öngörmede SOFA ve GKS'ye göre daha iyi olduğunu gösterdi.

Anahtar Kelimeler:

Sıvı tedavisi, sepsis, şok, mekanik ventilasyon, yoğun bakım

The effect of fluid balance on outcomes in patients with sepsis; experience of a tertiary hospital

Purpose: Fluid replacement is vital for stabilizing hemodynamic status in sepsis. However, the positive fluid balance may result in pulmonary edema and may be associated with increased mortality.Materials and methods: This is a single-center, retrospective study in which the patients, supported with mechanical ventilation (MV) due to sepsis, were enrolled. All the data about the demographic features, medications, MV duration, vital signs, blood gas analysis, blood tests, the fluid balance were obtained from the patient files and nursing reports. Patients were subclassed positive, negative and balanced according to fluid balance and compared to each other.Results: A total of fifty patients with sepsis were included in the study. Twenty-six (52%) of the patients were male and the mean age was 66.58±3.25 years. The mortality rate was 90%. The mean fluid intake and output were 3481.8±1002.7, 1877.6±921.3 milliliters, respectively. Forty-two (84%) were in positive fluid balance, 6 (12%) in negative fluid balance, and 2 (4%) in balance. There was no significant difference between the fluid balance subgroups in terms of length of stay in the ICU, duration of mechanical ventilation, and mortality. The use of diuretics was significantly higher in patients with positive fluid balance (p=0.023). CRP was significantly higher while serum albumin was lower in patients with positive fluid balance (respectively, p=0.003, p=0.034). There was no difference between the mean GCS, SOFA scores of survivors and nonsurvivors but the mean APACHE II scores in nonsurvivors were significantly higher than in survivors (p=0.026).Conclusion: Our study showed that positive fluid balance did not affect the length of stay in the ICU, duration of mechanical ventilation and mortality, and that APACHE II was better than SOFA and GCS in predicting mortality.

Keywords:

Fluid therapy, sepsis, shock, mechanical ventilation, intensive care,

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