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

Matthias Jacob; Sambit Sahu; Yogendra P Singh; Yatin Mehta; Kuang-Yao Yang; Shuenn-Wen Kuo; Farooq Memom; Shirish Prayag; Rajesh Pande; Nirmal Jaiswal; Tan C Cheng; Amit Mandal; Shanti R Deva; Mohan Mathew; Nagarajan Ramakrishnan; Vineya Rai; Luah Wah; Gopinath Ramachandran; Rajesh Chawla; Z A Khan; J V Divatia; Rajesh Mishra; Pravin Amin; Jayant Shelgaokar; Bernhard Zwissler; Hugo Van Aken; Christian Ertmer

doi:10.5005/jp-journals-10071-23653

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 Nov;24(11):1028-1036. doi: 10.5005/jp-journals-10071-23653.

Authors

Matthias Jacob¹, Sambit Sahu², Yogendra P Singh³, Yatin Mehta⁴, Kuang-Yao Yang⁵, Shuenn-Wen Kuo⁶, Farooq Memom⁷, Shirish Prayag⁸, Rajesh Pande⁹, Nirmal Jaiswal¹⁰, Tan C Cheng¹¹, Amit Mandal¹², Shanti R Deva¹³, Mohan Mathew¹⁴, Nagarajan Ramakrishnan¹⁵, Vineya Rai¹⁶, Luah Wah¹⁷, Gopinath Ramachandran¹⁸, Rajesh Chawla¹⁹, Z A Khan²⁰, J V Divatia²¹, Rajesh Mishra²², Pravin Amin²³, Jayant Shelgaokar²⁴, Bernhard Zwissler²⁵, Hugo Van Aken²⁶, Christian Ertmer²⁶

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.

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.

Keywords: Acute kidney injury; Colloids; Critical illness; Crystalloids; Fluid therapy; Hydroxyethyl starch.