Balanço hídrico e desfechos adversos em pacientes com Covid-19 em unidade de terapia intensiva

Abstract

Volume control in intensive care unit (ICU) is essential for the management of patients, and fluid balance has been suggested a valuable biomarker of critical illness. A positive association between positive fluid balance and mortality has been reported, but the impact of fluid balance and fluid overload has not been evaluated in patients with coronavirus disease 2019 (COVID-19). The aim of the present study was to evaluate the importance of fluid balance in COVID-19 patients admitted to ICU and its association with Kidney replacement therapy and mortality. Observational study including individuals admitted to ICU patients with an ICU stay longer than 24 hours. Exclusion criteria were age under 18 years, chronic dialysis and individuals with cerebral death. Files were revised for patient clinical characteristics, fluid administration and balance, physiological and laboratory data, diagnoses, and given treatment using case report forms. Data on fluid balance were recorded from admission to day 7. Increased in fluids of at least 5 and 10% were considered as fluid overload. Special attention was given to death, need of invasive mechanical ventilation, vasopressor drugs and dialysis A total of 176 intensive care patients with COVID-19 were included. Mean age was 58.7 (SD 15.4) years, and male to female ratio was almost 1. Most patient died (N 97, 55.1%), Kidney replacement therapy was performed in 32 (18.2%), invasive mechanical ventilation in 159 (90.3 %) and vasopressor was used in 140 (79.5%) patients. Mortality was increased in patients with a higher positive fluid balance. Median daily fluid balance was higher in non survivors than survivors, in dialysis than non-dialysis patients and in patients receiving invasive mechanical ventilation. Fluid overload defined with a threshold of 10% and 5% were used to design survival curves for mortality and for starting dialysis. Death and the probability of receiving dialysis were increases with fluid overload above 10 and 5%. In conclusion the present study shows that positive fluid balance in intensive care patients with COVID-19 is associated with mortality and need of Kidney replacement therapy and invasive mechanical ventilation. We are not aware of other studies disclosing such association in patients with SARS-CoV-2 infection in ICU. Further work is needed to evaluate if preventive measures to reduce fluid balance, restrictive fluid resuscitation, use of diuretics, or early kidney replacement therapy to treat fluid overload are effective in reducing mortality and morbidity.