The Association between Daily Fluid Balance and Mean Perfusion Pressure as a Critical Sign in the Intensive Care Unit of Adam Malik Central Hospital, Medan

Authors

DOI:

https://doi.org/10.3889/oamjms.2021.6282

Keywords:

Critical sign, Daily fluid balance, Mean perfusion pressure

Abstract

BACKGROUND: The patient mortality rate in intensive care unit (ICU) is still high. However, we still lack measures to reduce this high mortality rate. Fluid balance is known as a marker for mortality in ICU. If the balance of fluid becomes more positive, the mortality rate consequently becomes higher. Positive fluid balance elevates central venous pressure (CVP), while this elevation increases the risk of renal failure and mortality. Mean perfusion pressure (MPP) is the difference between mean arterial pressure and CVP.

AIM: We propose that the MPP value can be used as an alternative indicator to monitor excessive fluid balance since its measurement is faster and more accurate than the manual 24 h record of fluid balance.

PATIENTS AND METHODS: It is expected that we can prevent excessive fluid accumulation and the subsequent mortality risk by monitoring MPP in the ICU. To investigate the association between MPP and daily fluid balance in the ICU, a prospective study was conducted from March 2016 to August 2018 in the ICU of Adam Malik Hospital, Medan. During the study period, 76 patients were admitted. Sixty-point 5% were male, with the mean age of 48.3 ± 16.5 years old.

RESULTS: The overall mortality of 76 patients was 10.5%, and there was a significant negative correlation found between MPP and fluid balance (r = −0.204; p = 0.048), where a lower MPP value was associated with a more positive fluid balance.

CONCLUSIONS: We conclude that there is a negative correlation between MPP and fluid balance, where a more positive fluid balance is associated with a lower MPP value. The positive fluid balance had been previously associated with increased mortality risk in the ICU.

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References

Silversides JA, Pinto R, Kuint R, Wald R, Hladunewich MA, Lapinsky SE, et al. Fluid balance, intradialytic hypotension, and outcomes in critically ill patients undergoing renal replacement therapy: A cohort study. Crit Care. 2014;18(6):624. https://doi.org/10.1186/s13054-014-0624-8 PMid:25407408 DOI: https://doi.org/10.1186/s13054-014-0624-8

Perren A, Markmann M, Merlani G, Marone C, Merlani P. Fluid balance in critically ill patients. Should we really rely on it? Minerva Anestesiol. 2011;77(8):802-11. PMid:21730928

Malbrain ML, Marik PE, Witters I, Cordemans C, Kirkpatrick AW, Roberts DJ, et al. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: A systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther. 2014;46(5):361-80. https://doi.org/10.5603/ait.2014.0060 PMid:25432556 DOI: https://doi.org/10.5603/AIT.2014.0060

Kelm DJ, Perrin JT, Cartin-Ceba R, Gajic O, Schenck L, Kennedy CC. Fluid overload in patients with severe sepsis and septic shock treated with early goal-directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death. Shock. 2015;43(1):68-73. https://doi.org/10.1097/shk.0000000000000268 PMid:25247784 DOI: https://doi.org/10.1097/SHK.0000000000000268

Goldstein S, Bagshaw S, Cecconi M, Okusa M, Wang H, Kellum J, et al. Pharmacological management of fluid overload. Br J Anaesth. 2014;113(5):756-63. https://doi.org/10.1093/bja/aeu299 PMid:25209097 DOI: https://doi.org/10.1093/bja/aeu299

Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. Fluid resuscitation in septic shock: A positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011;39(2):25965. https://doi.org/10.1097/ccm.0b013e3181feeb15 PMid:20975548 DOI: https://doi.org/10.1097/CCM.0b013e3181feeb15

Cordemans C, de Laet I, van Regenmortel N, Schoonheydt K, Dits H, Malbrain ML, et al. Fluid management in critically ill patients: The role of extravascular lung water, Abdominal hypertension, Capillary leak, And fluid balance. Ann Intensive Care. 2012;2012 Suppl 1:S1. https://doi.org/10.1186/2110-5820-2-s1-s1 PMid:22873410 DOI: https://doi.org/10.1186/2110-5820-2-S1-S1

Bouchard JE, Mehta RL. Fluid balance issues in the critically Ill patient. Contrib Nephrol. 2010;164:69-78. PMid:20427995 DOI: https://doi.org/10.1159/000313722

Long Y, Su L, Zhang Q, Zhou X, Wang H, Cui N, et al. Elevated mean airway pressure and central venous pressure in the first day of mechanical ventilation indicated poor outcome. Crit Care Med. 2017;45(5):e485-92. https://doi.org/10.1097/ccm.0000000000002290 PMid:28244940 DOI: https://doi.org/10.1097/CCM.0000000000002290

Williams JB, Peterson ED, Wojdyla D, Harskamp R, Southerland KW, Ferguson TB, et al. Central venous pressure after coronary artery bypass surgery: Does it predict postoperative mortality or renal failure? J Crit Care. 2014;29(6):1006-10. https://doi.org/10.1016/j.jcrc.2014.05.027 PMid:25035048 DOI: https://doi.org/10.1016/j.jcrc.2014.05.027

Damman K, van Deursen VM, Navis G, Voors AA, van Veldhuisen DJ, Hillege HL. Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. J Am Coll Cardiol. 2009;53(7):582-8. https://doi.org/10.1016/j.jacc.2008.08.080 PMid:19215832 DOI: https://doi.org/10.1016/j.jacc.2008.08.080

Patel R, Solanki A, Patel H, Pandya H, Patel J, Patel S. Does mean perfusion pressure during cardiopulmonary bypass affect renal function? J Evid Based Med Healthc. 2015;2(41):6946-53. https://doi.org/10.18410/jebmh/2015/948 DOI: https://doi.org/10.18410/jebmh/2015/948

Ostermann M, Hall A, Crichton S. Low mean perfusion pressure is a risk factor for progression of acute kidney injury in critically ill patients-a retrospective analysis. BMC Nephrol. 2017;18(1):151. https://doi.org/10.1186/s12882-017-0568-8 PMid:28468613 DOI: https://doi.org/10.1186/s12882-017-0568-8

Payen D, de Pont AC, Sakr Y, Spies C, Reinhart K, Vincent JL. A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care. 2008;12(3):R74. https://doi.org/10.1186/cc6916 PMid:18533029 DOI: https://doi.org/10.1186/cc6916

Bouchard J, Soroko SB, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP, et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int. 2009;76(4):422-7. https://doi.org/10.1038/ki.2009.159 PMid:19436332 DOI: https://doi.org/10.1038/ki.2009.159

Wang N, Jiang L, Zhu B, Wen Y, Xi XM. Fluid balance and mortality in critically ill patients with acute kidney injury: A multicenter prospective epidemiological study. Crit Care. 2015;19(1):371. https://doi.org/10.1186/s13054-015-1085-4 PMid:26494153 DOI: https://doi.org/10.1186/s13054-015-1085-4

Panwar R, Lanyon N, Davies AR, Bailey M, Pilcher D, Bellomo R. Mean perfusion pressure deficit during the initial management of shock-an observational cohort study. J Crit Care. 2013;28(5):816-24. https://doi.org/10.1016/j.jcrc.2013.05.009 PMid:23849541 DOI: https://doi.org/10.1016/j.jcrc.2013.05.009

Bagshaw SM, Brophy PD, Cruz D, Ronco C. Fluid balance as a biomarker: Impact of fluid overload on outcome in critically ill patients with acute kidney injury. Crit Care. 2008;12(4):169. https://doi.org/10.1186/cc6948 PMid:18671831 DOI: https://doi.org/10.1186/cc6948

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Published

2021-06-04

How to Cite

1.
Lubis B, Amelia P, Akil M. The Association between Daily Fluid Balance and Mean Perfusion Pressure as a Critical Sign in the Intensive Care Unit of Adam Malik Central Hospital, Medan. Open Access Maced J Med Sci [Internet]. 2021 Jun. 4 [cited 2024 Apr. 21];9(T3):52-5. Available from: https://oamjms.eu/index.php/mjms/article/view/6282

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