Delmas Benito, L. (Laura) (2017) Do organizational measures lead to a reduction in the use of fluid therapy in post-surgical cardiovascular patients admitted to the ICU? : A retrospective single-center observational study. thesis, Medicine.
Full text available on request.Abstract
Objective: To study the influence of a change in organizational measures on (para)medical behavior and adherence to fluid resuscitation protocol. Introduction: Fluid therapy remains the foundation of shock resuscitation, but recent studies have highlighted the potential dangers of fluid overload. Strategies have been developed to measure fluid responsiveness, and protocols have been established to apply responsible fluid resuscitation. However, studies show that adherence to protocols by healthcare providers remains a challenge. Materials & Methods: The fluid balance (FB), after 12 hours of Intensive Care Unit (ICU) admission, of 750 post-cardio surgical patients were retrospectively evaluated after two different organizational measures, designed to influence (para)medical behavior, were implemented. Patients were divided into three groups: those receiving 500ml fluid boluses (group A), those receiving 250ml fluid boluses (group B) and those with a continuous FB registration throughout the entire hospitalization (group C). Results: 3 × 250 patients were included. Group C showed a significant reduction in FB in the first 12 hours of ICU admission in comparison to groups A and B(p<0.001), but group B showed no significant reduction in FB compared to the historical group (group A) (p=0.96). Furthermore, in a multivariate analysis a high cumulative fluid balance was associated with a higher risk for prolonged mechanical ventilation (MV) (OR=1.5) and prolonged length of stay (LOS) in the ICU (OR= 2.0). Conclusion: The implementation of a continuous FB registration system was associated with a significant reduction in fluid administration in the first 12 hours of ICU admission post-cardiac surgery. This reduction in turn lowers the risk of prolonged MV and LOS.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Medical Center Leeuwarden Intensive Care Unit and Daily supervisor and mentor and Boerma, dr. E.C. and Internist-Intensivist |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:58 |
| Last Modified: | 25 Jun 2020 10:58 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1890 |
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