巴西圣保罗HCor研究所Alexandre B. Cavalcanti团队研究了慢速静脉输液与快速静脉输液对危重病人死亡率的影响。相关论文于2021年8月10日发表于《美国医学会杂志》上。
降低静脉输液速度可减少危重患者组织水肿和器官功能障碍的形成。然而，尚未有数据支持在输液过程中不同输注速率对重要结局如死亡率的影响。
为了研究较慢输液速率与对照输液速率对重症监护病房（ICU）患者90天生存率的影响，2017年5月29日至2020年3月2日，研究组在巴西的75个ICU病房进行了一项非盲、随机析因临床试验，共招募了11052名至少需要输液1次并有1个恶化预后危险因素的患者。随访于2020年10月29日结束。
患者被随机分配到2种不同的输注速率（在本文中报道）和2种不同的液体类型（平衡液体或生理盐水，分别报道）。患者随机接受2种不同输液速率的液体挑战，其中5538例转为慢速输液（333 mL/h），5514例转为对照组（999 mL/h）。采用析因设计，患者还随机接受平衡溶液或0.9%生理盐水。主要终点为90天生存期。
在所有随机化患者中，共有10520名（95.2%）进入最终分析，平均年龄为61.1岁，44.2%为女性。分配到较慢速率的患者在第一天的平均输液量为1162毫升，而对照组为1252毫升。到第90天时，慢速输液组5276名患者中有1406名（26.6%）死亡，而对照组5244名患者中有1414名（27.0%）死亡，组间差异不显著。液体类型与输注速率之间无显著交互作用。
研究结果表明，在需要液体输注的ICU患者中，与快速输液相比，慢速输液并不能降低90天死亡率。
附：英文原文
Title: Effect of Slower vs Faster Intravenous Fluid Bolus Rates on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial
Author: Fernando G. Zampieri, Flávia R. Machado, Rodrigo S. Biondi, Flávio G. R. Freitas, Viviane C. Veiga, Rodrigo C. Figueiredo, Wilson J. Lovato, Cristina P. Amêndola, Murillo S. C. Assuno, Ary Serpa-Neto, Jorge L. R. Paranhos, José Andrade, Michele M. G. Godoy, Edson Romano, Felipe Dal Pizzol, Emerson B. Silva, Miqueias M. L. Silva, Miriam C. V. Machado, Luiz Marcelo S. Malbouisson, Airton L. O. Manoel, Marlus M. Thompson, Lanese M. Figueiredo, Rafael M. Soares, Tamiris A. Miranda, Lucas M. de Lima, Eliana V. Santucci,, Thiago D. Corrêa, Luciano C. P. Azevedo, John A. Kellum, Lucas P. Damiani, Nilton B. Silva, Alexandre B. Cavalcanti, GradD, GradD, BaSICS investigators and the BRICNet members, Rodrigo Biondi, Bruno C. R. Amaral, Edvar Ferreira R., Andrea Z. Abdalla, Flávio G. R. de Freitas, Nathaly F. Nunes, Rodrigo C. da Cunha, Elijane F. Alves, Rodrigo C. Figueiredo, Rodrigo B. Bortolini, Cintia L. Sartori, Eduardo S. Marques, Maria A de Sousa, Danieri Y. V. Tomotani, Airton L. O. Manoel, Wilson J. Lovato, Bruno G. Dantas, Leonardo C. Palma, Fábio L. da Silva, Cristina P. Amendola, Luciana C. Sanches, Fernanda A. M. Scuoteguazza, Ligia Z. de Britto, Ary Serpa, Niklas S. Campos, Fabio B. Hohmann, Guilherme B. Olivato, Jorge L.R. Paranhos, Iany G. da Silva, Adilson de C. Meireles, Viviane C. Veiga, Juliana C. Coelho, Maiko M. Silveira, Agnes C. Lisboa, Marco A.V. Guedes, Luiz C.S. Passos, Daniela C. Dorta, Ramana A. Rangel
Issue&Volume: 2021-08-10
Abstract:
Importance Slower intravenous fluid infusion rates could reduce the formation of tissue edema and organ dysfunction in critically ill patients; however, there are no data to support different infusion rates during fluid challenges for important outcomes such as mortality.
Objective To determine the effect of a slower infusion rate vs control infusion rate on 90-day survival in patients in the intensive care unit (ICU).
Design, Setting, and Participants Unblinded randomized factorial clinical trial in 75 ICUs in Brazil, involving 11052 patients requiring at least 1 fluid challenge and with 1 risk factor for worse outcomes were randomized from May 29, 2017, to March 2, 2020. Follow-up was concluded on October 29, 2020. Patients were randomized to 2 different infusion rates (reported in this article) and 2 different fluid types (balanced fluids or saline, reported separately).
Interventions Patients were randomized to receive fluid challenges at 2 different infusion rates; 5538 to the slower rate (333 mL/h) and 5514 to the control group (999 mL/h). Patients were also randomized to receive balanced solution or 0.9% saline using a factorial design.
Main Outcomes and Measures The primary end point was 90-day survival.
Results Of all randomized patients, 10520 (95.2%) were analyzed (mean age, 61.1 years [SD, 17.0 years]; 44.2% were women) after excluding duplicates and consent withdrawals. Patients assigned to the slower rate received a mean of 1162 mL on the first day vs 1252 mL for the control group. By day 90, 1406 of 5276 patients (26.6%) in the slower rate group had died vs 1414 of 5244 (27.0%) in the control group (adjusted hazard ratio, 1.03; 95% CI, 0.96-1.11; P=.46). There was no significant interaction between fluid type and infusion rate (P=.98).
Conclusions and Relevance Among patients in the intensive care unit requiring fluid challenges, infusing at a slower rate compared with a faster rate did not reduce 90-day mortality. These findings do not support the use of a slower infusion rate.
DOI: 10.1001/jama.2021.11444
Source: https://jamanetwork.com/journals/jama/fullarticle/2783040
JAMA-Journal of The American Medical Association：《美国医学会杂志》，创刊于1883年。隶属于美国医学协会，最新IF：157.335
官方网址：https://jamanetwork.com/
投稿链接：http://manuscripts.jama.com/cgi-bin/main.plex
本期文章：《美国医学会杂志》：Online/在线发表
