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

Jacob M 1 , Sahu S 2 , Singh YP 3 , Mehta Y 4 , Yang KY 5 , Kuo SW 6 Show all authors , Memom F 7 , Prayag S 8 , Pande R 9 , Jaiswal N 10 , Cheng TC 11 , Mandal A 12 , Deva SR 13 , Mathew M 14 , Ramakrishnan N 15 , Rai V 16 , Wah L 17 , Ramachandran G 18 , Chawla R 19 , Khan ZA 20 , Divatia JV 21 , Mishra R 22 , Amin P 23 , Shelgaokar J 24 , Zwissler B 25 , Van Aken H 26 , Ertmer C 26

Affiliations 

  • 1 Department of Anesthesiology and Surgical Intensive Care, St. Elisabeth Hospital, Straubing, Germany
  • 2 Krishna Institute of Medical Science, Secunderabad, Andhra Pradesh, India
  • 3 Department of Critical Care Medicine, Max Super Specialty Hospital, Patparganj, New Delhi, India
  • 4 Institute of Critical Care and Anesthesiology, Medanta: The Medicity, Gurugram, Haryana, India
  • 5 Department of Chest Medicine, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan
  • 6 National Taiwan University Hospital, Taipei City, Taiwan
  • 7 Rajasthan Hospital, Ahmedabad, Gujarat, India
  • 8 Internal Medicine and Critical Care, Prayag Hospital, Deccan Gymkhana, Pune, India
  • 9 Department of Critical Care Medicine, BLK Center for Critical Care, BLK Superspeciality Hospital, New Delhi, India
  • 10 Suretech Hospital, Dhantoli, Maharashtra, India
  • 11 Sultanah Aminah Hospital, Johor Bahru, Johor, Malaysia
  • 12 Fortis Hospital, Mohali, Punjab, India
  • 13 Jalan Pahang, Kuala Lumpur, Malaysia
  • 14 Lakeshore Hospital and Research Centre, Kochi, Kerala, India
  • 15 Critical Care Services, Apollo Hospitals, Chennai, Tamil Nadu, India
  • 16 Department of Anesthesiology, KPJ Tawakkal Specialist Hospital, Jalan Pahang Barat, Kuala Lumpur, Malaysia
  • 17 Jalan Residensi, Pulau Pinang, Malaysia
  • 18 Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
  • 19 Respiratory and Critical Care Medicine, Indraprastha, Apollo Hospitals, New Delhi, India
  • 20 Noble Hospital, Pune, Maharashtra, India
  • 21 Department of Anesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
  • 22 Sanjivani Super Specialty Hospital, Ahmedabad, Gujarat, India
  • 23 Bombay Hospitals and Medical Research Center, Mumbai, Maharashtra, India
  • 24 Department of Critical Care, Aditya Birla Memorial Hospital, Aditya Birla Hospital Marg, Pune, Maharashtra, India
  • 25 Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
  • 26 Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
Indian J Crit Care Med, 2020 Nov;24(11):1028-1036.
PMID: 33384507 DOI: 10.5005/jp-journals-10071-23653

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.

How to cite this article: Jacob M, Sahu S, Singh YP, Mehta Y, Yang K-Y, Kuo S-W, et al. 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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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