Original scientific paper
EFFECT OF CUMULATIVE FLUID BALANCE DURING ICU STAY ON IN-HOSPITAL MORTALITY IN PATIENTS SURGICALLY TREATED FOR INFECTIVE ENDOCARDITIS
ANDREJ ŠRIBAR
orcid.org/0000-0002-6517-9895
; Dubrava University Hospital, Zagreb, Croatia
VLASTA KLARIĆ
; Dubrava University Hospital, Zagreb, Croatia
VERICA MIKECIN
; Dubrava University Hospital, Zagreb, Croatia
VLADIMIR KRAJINOVIĆ
; Dr. Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia
IVAN MILAS
; Zagreb University Hospital Centre, Zagreb, Croatia
JASMINKA PERŠEC
orcid.org/0000-0002-3777-8153
; Dubrava University Hospi and University of Zagreb, School of Dental Medicine, Zagreb, Croatia
Abstract
Introduction: Infective endocarditis (IE) is an infl ammatory disease of endocardium caused by bacteria or fungi. It is caused microbial adhesion to endocardial surface caused by the presence of bacteria or fungi in the bloodstream. Its clinical features are fever, malaise, heart murmurs, shortness of breath and symptoms caused by septic emboli. Current standard in the diagnosis of IE are Duke criteria, according to which two major (echocardiographic evidence and positive blood cultures for most common infective agents that cause IE), one major and three minor or fi ve minor (pre-existing cardiac conditions, fever, vascular phenomena, immunologic phenomena and positive blood cultures) criteria need to be present to confi rm the diagnosis of IE. It is treated with targeted antimicrobial therapy, and open-heart surgery using cardiopulmonary bypass is performed if there is persistent bacteremia, signifi cant hemodynamic instability or threat of septic embolization. Hemodynamic instability is common during postoperative period due to systemic infl ammatory response and myocardial injury after cardiopulmonary bypass and it is treated with volume replacement and vasoactive drugs. Aim: The aim of this study was to determine whether increased fl uid balance during intensive care unit (ICU) stay after IE surgery had an effect on in-hospital mortality, duration of mechanical ventilation and ICU stay, need for renal replacement therapy and postoperative lung function. Sixty-fi ve patients operated for native valve IE and treated in ICU specialized for cardiac patients in a tertiary hospital were included in this observational study. Design of the study was approved by the institutional ethics committee. Patients with pre-existing lung disease, history of malignant disease in the last 5 years, or history of organ transplantation were excluded. Demographic data (age and gender), clinical variables needed to calculate SOFA (sepsis related organ failure assessment) score, ventilator settings, fl uid gains and losses during ICU stay, duration of mechanical ventilation and ICU stay, PaO2/FiO2 ratio at ICU admission and at 3, 6, 12 and 24 h post-admission, and in-hospital mortality data were collected. There were 55 (85%) male and ten (15%) female patients, mean age 54.2±15 years. Median fl uid gain/loss balance was +1190 mL (IQR -120 mL - +3090 mL), median duration of mechanical ventilation was 17 h (IQR 13.5-22.5 h) and median duration of ICU stay was 60 h (IQR 42-82 h). Ten (15%) patients died during hospital stay. Non-survivors had a signifi cantly higher proportion of fl uid balance above median (70% vs. 30%) compared to survivors (56% vs. 44%) (p=0.05, age and SOFA score adjusted binomial logistic regression with post-hoc Bonferroni correction). Correlation was found between duration of mechanical ventilation and ICU stay (Spearman’s
Keywords
infective endocarditis; intensive care unit; cardiac surgery; mechanical ventilation
Hrčak ID:
208486
URI
Publication date:
16.11.2018.
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