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Research Snapshot Theater: Quality and Patient Safety/Resuscitation, Adult

(1307) An Observational Study of Fluid Overload in a Community Hospital ICU

Tuesday, January 23, 2024
10:00 AM – 11:00 AM MT
Location: Connections Central - RST 13
Introduction: Recent studies have shown that fluid overload (FO) in critically ill patients might be associated with higher mortality and prolonged intubation and ICU stay. FO is a consequence of intentional fluid resuscitation and indirect fluid administration (i.e., IV flushes, medication diluents, etc.) Surveys showed that physicians view FO as a major modifiable source of morbidity in critically ill patients. Challenges to prevent FO include complex fluid management protocols, heterogeneity of ICU patients, and inconsistent measures of fluid balance and weight. We hypothesized that cumulative fluid balance (CFB) > 5L at intubation day 3 can identify patients with FO (CFB > 7L) at intubation day 7. If so, a clinical decision support alert (CDSA) can be developed to prevent severe FO and it’s complications.

Methods: This is a retrospective study conducted at a community hospital with 325 beds in urban Arizona. Adult patients (age > 18) admitted to ICU from 2/15/2022-2/15/2023, intubated within 48 hours of admission for at least 72 hours were included. We tested the criterion, day-3 CFB> 5L, on all patients and examined if they had FO at day 7 (CFB >7L).

Results: A total of 133 patients were included for the study, of which 26 (20%) experienced FO. Fifty-seven (43%) had CFB > 5L at intubation day 3. Among which, 22 (39%) experienced FO. Only four (5%) out of 76 patients with day-3 CFB <= 5L experienced FO. Day-3 CFB had a sensitivity of 85% (95% CI: 65-96%), and a specificity of 67% (95% CI: 57-76%) for predicting FO. The average day-7 CFB of patients who had day-3 CFB>5L was 12.2L compared to 2.3L for those who did not (p < 0.05).

Conclusions: A simple criterion at day 3 on ICU patients’ fluid status can identify 85% patients with FO (CFB > 7L) at day 7. We intend to develop a CDSA using this criterion to assist physicians to start fluid restriction early to prevent severe FO. A prospective study to further exam such an alert’s accuracy and effect is needed.